Provider Demographics
NPI:1659785319
Name:WHITLOCK, IRIS (LPC LPC-I)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:LPC LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13717 CINNABAR PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5342
Mailing Address - Country:US
Mailing Address - Phone:704-962-1924
Mailing Address - Fax:
Practice Address - Street 1:13717 CINNABAR PL
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5342
Practice Address - Country:US
Practice Address - Phone:704-962-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2017-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6216101YM0800X
NC10758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health