Healthcare Provider Details

I. General information

NPI: 1245888130
Provider Name (Legal Business Name): PRESTON WHITLOW LCMHCA, LCAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 S MADISON BLVD
ROXBORO NC
27573-5485
US

IV. Provider business mailing address

104 NEW STATESIDE DR
CHAPEL HILL NC
27516-1213
US

V. Phone/Fax

Practice location:
  • Phone: 434-429-7605
  • Fax:
Mailing address:
  • Phone: 434-429-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25223
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA16689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: