Provider Demographics
NPI:1376114199
Name:WHITMORE, JOY NICOLE (CSW)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:NICOLE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BLACKBURN AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2712
Mailing Address - Country:US
Mailing Address - Phone:404-553-1560
Mailing Address - Fax:
Practice Address - Street 1:2020 NEWBURG RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1803
Practice Address - Country:US
Practice Address - Phone:502-479-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY257556104100000X
GAMSW010105104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker