Provider Demographics
NPI:1821643222
Name:WHITMAN, KELLY LANE (LADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LANE
Last Name:WHITMAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LANE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:244 HIGH WATCH RD
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03882-8336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:244 HIGH WATCH RD
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:NH
Practice Address - Zip Code:03882-8336
Practice Address - Country:US
Practice Address - Phone:603-539-8743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1091101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor