MEDICARE: DR. AUDREY MARIE WHITLEY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1836	SC

General Provider Information

NPI Number	:	1528821675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUDREY MARIE WHITLEY PH.D.

Provider Business Mailing Address
First Line	:	522 POINSETTIA DR
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-3439
Country	:	US
Telephone Number	:	864-979-2865
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E WASHINGTON ST STE K
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-3054
Country	:	US
Telephone Number	:	864-569-7768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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