Provider Demographics
NPI:1972230688
Name:WHITLOW, ANTHONY (CDCAI)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:WHITLOW
Suffix:
Gender:M
Credentials:CDCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2357 HAMPSTEAD DR STE 9
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2852
Mailing Address - Country:US
Mailing Address - Phone:614-568-8236
Mailing Address - Fax:
Practice Address - Street 1:5460 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4074
Practice Address - Country:US
Practice Address - Phone:614-568-8236
Practice Address - Fax:614-426-4731
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161755104100000X
OHCDCA.178466104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker