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General NPI Number Information
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NPI Number | 1265567234
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Entity Type | Individual
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Provider Name | KIRSTIN LOUISE WHITELY C.T.R.S.
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Gender | Female
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 6097 PREAKNESS STAKES LN
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City | POWHATAN
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State | VA
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Zip | 23139-7092
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Country | US
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Telephone | 330-573-2076
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Fax |
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Provider Business Mailing Address
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Address Line | 6097 PREAKNESS STAKES LN
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City | POWHATAN
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State | VA
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Zip | 23139-7092
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Country | US
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Telephone | 330-573-2076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 070026
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 51168
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number | 51168
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License Number State | VA
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