Provider Demographics
NPI:1942546965
Name:WHISNANT, JASON RANDALL (LPCA)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RANDALL
Last Name:WHISNANT
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:RANDALL
Other - Last Name:WHISNANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, EDS, LPCA
Mailing Address - Street 1:140 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3515
Mailing Address - Country:US
Mailing Address - Phone:828-443-2488
Mailing Address - Fax:
Practice Address - Street 1:140 BEACH ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3515
Practice Address - Country:US
Practice Address - Phone:828-475-0149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9885101YM0800X
NC9885101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA9885OtherLICENSE #
NC1942546965Medicaid
NC177XVOtherBCBSNC