Provider Demographics
NPI:1811359771
Name:WHITLEY, CHASITY RACHEL (LISW, LCDC III)
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:RACHEL
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LISW, LCDC III
Other - Prefix:
Other - First Name:CHASITY
Other - Middle Name:RACHEL
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4761 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-8216
Mailing Address - Country:US
Mailing Address - Phone:419-584-1000
Mailing Address - Fax:419-584-1825
Practice Address - Street 1:4761 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-8216
Practice Address - Country:US
Practice Address - Phone:419-584-1000
Practice Address - Fax:419-584-1825
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.161697101YA0400X
OHI18000889104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty