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General NPI Number Information
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NPI Number | 1497357214
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Entity Type | Individual
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Provider Name | BRANDON WHIGHAM LPC, LCADC, ACS, NCC
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Gender | Male
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 471 TREMONT AVE APT 9S
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City | SOUTH ORANGE
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State | NJ
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Zip | 07050
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Country | US
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Telephone | 862-214-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 4 S ORANGE AVE # 225
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-1702
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Country | US
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Telephone | 862-214-4939
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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 | 37LC00347000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00738200
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License Number State | NJ
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