Provider Demographics
NPI:1558648832
Name:WHICHARD, TAKARA (MS, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:TAKARA
Middle Name:
Last Name:WHICHARD
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 ELMSTEAD DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-5822
Mailing Address - Country:US
Mailing Address - Phone:252-327-0168
Mailing Address - Fax:
Practice Address - Street 1:1221 ELMSTEAD DR
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-5822
Practice Address - Country:US
Practice Address - Phone:252-327-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21165101YA0400X
NC8655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)