Provider Demographics
NPI:1245888130
Name:WHITLOW, PRESTON (LCAS)
Entity type:Individual
Prefix:
First Name:PRESTON
Middle Name:
Last Name:WHITLOW
Suffix:
Gender:M
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MAPLE ST APT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-2960
Mailing Address - Country:US
Mailing Address - Phone:434-429-7605
Mailing Address - Fax:
Practice Address - Street 1:215 S MAPLE ST APT E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-2960
Practice Address - Country:US
Practice Address - Phone:434-429-7605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)