Provider Demographics
NPI:1346958071
Name:WHELAN, MARIE KATHERYN (APCC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:KATHERYN
Last Name:WHELAN
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1761
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-8761
Mailing Address - Country:US
Mailing Address - Phone:925-489-5953
Mailing Address - Fax:
Practice Address - Street 1:1120 2ND ST STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2225
Practice Address - Country:US
Practice Address - Phone:925-489-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC12438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health