Healthcare Provider Details

I. General information

NPI: 1801357223
Provider Name (Legal Business Name): JANAY WHITTAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983 MAR DON DR
WINSTON SALEM NC
27104-4624
US

IV. Provider business mailing address

983 MAR DON DR
WINSTON SALEM NC
27104-4624
US

V. Phone/Fax

Practice location:
  • Phone: 336-923-7426
  • Fax: 704-625-3617
Mailing address:
  • Phone: 336-923-7426
  • Fax: 704-625-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012921
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: