Provider Demographics
NPI:1154447001
Name:WHITAKER, CHARLOTTE PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:PATRICIA
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 MAPLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-8302
Mailing Address - Country:US
Mailing Address - Phone:828-980-0855
Mailing Address - Fax:828-382-0171
Practice Address - Street 1:516 MAPLE CREEK RD
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-8302
Practice Address - Country:US
Practice Address - Phone:828-980-0855
Practice Address - Fax:828-328-0171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0056001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106843Medicaid