Provider Demographics
NPI:1659767952
Name:WHITTAKER, JOEY LEE (CADC 2)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:LEE
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:CADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 FERGUS AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1769
Mailing Address - Country:US
Mailing Address - Phone:541-653-1287
Mailing Address - Fax:
Practice Address - Street 1:627 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3923
Practice Address - Country:US
Practice Address - Phone:503-434-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)