Provider Demographics
NPI:1144582727
Name:WHITAKER, ROBERT JAVAN SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAVAN
Last Name:WHITAKER
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 COUNTRY PINES DR
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-6518
Mailing Address - Country:US
Mailing Address - Phone:318-230-2533
Mailing Address - Fax:
Practice Address - Street 1:239 COUNTRY PINES DR
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-6518
Practice Address - Country:US
Practice Address - Phone:318-230-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional