Provider Demographics
NPI:1326548330
Name:WHITSON, GENA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:GENA
Middle Name:
Last Name:WHITSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 CROSS HAVEN CLOSE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-7714
Mailing Address - Country:US
Mailing Address - Phone:815-997-4928
Mailing Address - Fax:
Practice Address - Street 1:5702 ELAINE DR STE 201
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2475
Practice Address - Country:US
Practice Address - Phone:815-997-4829
Practice Address - Fax:779-888-6892
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IL180.006972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health