Provider Demographics
NPI:1083093199
Name:K WHITAKER INC
Entity Type:Organization
Organization Name:K WHITAKER INC
Other - Org Name:WHITAKER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-394-3911
Mailing Address - Street 1:433 CALLAN AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4643
Mailing Address - Country:US
Mailing Address - Phone:510-394-3911
Mailing Address - Fax:
Practice Address - Street 1:433 CALLAN AVE
Practice Address - Street 2:STE 209
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4643
Practice Address - Country:US
Practice Address - Phone:510-394-3911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty