Provider Demographics
NPI:1922508019
Name:WHITLEY, JENNIFER NICHOLE (LPC-A)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6439
Mailing Address - Country:US
Mailing Address - Phone:910-232-1328
Mailing Address - Fax:910-833-5905
Practice Address - Street 1:1136 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6439
Practice Address - Country:US
Practice Address - Phone:910-232-1328
Practice Address - Fax:910-833-5905
Is Sole Proprietor?:No
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional