Provider Demographics
NPI:1427576123
Name:WHITMIRE, JEREMY WADE
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:WADE
Last Name:WHITMIRE
Suffix:
Gender:M
Credentials:
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 444
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-0444
Mailing Address - Country:US
Mailing Address - Phone:828-837-0071
Mailing Address - Fax:828-837-5309
Practice Address - Street 1:217 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771-8409
Practice Address - Country:US
Practice Address - Phone:828-479-6466
Practice Address - Fax:828-479-9267
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0086771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical