Provider Demographics
NPI:1174654099
Name:WHITLEY, LINDA JONES (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JONES
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 BIG MILL RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-8029
Mailing Address - Country:US
Mailing Address - Phone:252-799-9661
Mailing Address - Fax:252-792-6131
Practice Address - Street 1:110 BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2462
Practice Address - Country:US
Practice Address - Phone:252-799-9661
Practice Address - Fax:252-792-6131
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4098101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102684Medicaid
NC137UKOtherBCBSNC