Provider Demographics
NPI:1780414490
Name:WHITESIDE, JENNIFER B
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:WHITESIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 S WALNUT ST STE 323
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6803
Mailing Address - Country:US
Mailing Address - Phone:760-553-4085
Mailing Address - Fax:
Practice Address - Street 1:323 S WALNUT ST STE 323
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6803
Practice Address - Country:US
Practice Address - Phone:256-284-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health