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General NPI Number Information
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NPI Number | 1467194647
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Entity Type | Individual
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Provider Name | KRISTIN NICOLE WHITLEY CDCA
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Gender | Female
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Dates
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Enumeration Date | 04/08/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 2107 TROY RD APT E3
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City | SPRINGFIELD
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State | OH
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Zip | 45504-4245
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Country | US
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Telephone | 937-831-5517
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 TROY RD APT E3
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City | SPRINGFIELD
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State | OH
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Zip | 45504-4245
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Country | US
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Telephone | 937-831-5517
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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 | 178558
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License Number State | OH
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