Healthcare Provider Details

I. General information

NPI: 1235043381
Provider Name (Legal Business Name): ASHLEY NICOLE WHITTAKER CDCAPRE.197319
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 N CANFIELD NILES RD
AUSTINTOWN OH
44515-2343
US

IV. Provider business mailing address

2828 CLEARWATER ST NW
WARREN OH
44485-2212
US

V. Phone/Fax

Practice location:
  • Phone: 330-642-8242
  • Fax:
Mailing address:
  • Phone: 330-880-9791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.197319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: