Provider Demographics
NPI:1265567234
Name:WHITELY, KIRSTIN LOUISE (CTRS)
Entity type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:LOUISE
Last Name:WHITELY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6097 PREAKNESS STAKES LN
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7092
Mailing Address - Country:US
Mailing Address - Phone:330-573-2076
Mailing Address - Fax:
Practice Address - Street 1:6097 PREAKNESS STAKES LN
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7092
Practice Address - Country:US
Practice Address - Phone:330-573-2076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH070026101YA0400X
OH51168225800000X
VA51168225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)