Provider Demographics
NPI:1518242148
Name:WHITTINGTON-CLARK ASSOCIATES LLC
Entity Type:Organization
Organization Name:WHITTINGTON-CLARK ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITTINGTON-CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:419-578-2525
Mailing Address - Street 1:2525 W BANCROFT ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1311
Mailing Address - Country:US
Mailing Address - Phone:419-578-2525
Mailing Address - Fax:419-536-9220
Practice Address - Street 1:2525 W BANCROFT ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-1311
Practice Address - Country:US
Practice Address - Phone:419-578-2525
Practice Address - Fax:419-536-9220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4131103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWHCP05913OtherMEDICARE ID
OH0607794Medicaid
H049610Medicare UPIN