Provider Demographics
NPI:1770346603
Name:WHITACRE, MARK DEVAN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DEVAN
Last Name:WHITACRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4208
Mailing Address - Country:US
Mailing Address - Phone:540-542-0200
Mailing Address - Fax:
Practice Address - Street 1:180 GRAFTON LN
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-2576
Practice Address - Country:US
Practice Address - Phone:540-955-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician