Provider Demographics
NPI:1568757664
Name:CHILDRESS, WHITNEY DIANNE (MHPP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DIANNE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HARRISON ST RM 107
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-6906
Mailing Address - Country:US
Mailing Address - Phone:870-793-6774
Mailing Address - Fax:870-793-1997
Practice Address - Street 1:400 HARRISON ST RM 107
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-6906
Practice Address - Country:US
Practice Address - Phone:870-793-6774
Practice Address - Fax:870-793-1997
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator