Healthcare Provider Details

I. General information

NPI: 1235074840
Provider Name (Legal Business Name): WHIGHAM LEGACY TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 DOVER RD
ROCKY MOUNT NC
27804-2506
US

IV. Provider business mailing address

213 DOVER RD
ROCKY MOUNT NC
27804-2506
US

V. Phone/Fax

Practice location:
  • Phone: 757-403-1383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER WHIGHAN JR.
Title or Position: TRUSTEE
Credential: MHT
Phone: 757-403-1383