Provider Demographics
NPI:1801308176
Name:WHITAKER, CAROL LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 E MCANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5579
Mailing Address - Country:US
Mailing Address - Phone:541-301-7030
Mailing Address - Fax:
Practice Address - Street 1:1911 UNITED WAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4970
Practice Address - Country:US
Practice Address - Phone:541-301-7030
Practice Address - Fax:541-301-7030
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL48401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical