Provider Demographics
NPI:1821121641
Name:WHITELEY, JENNIFER ADELE (RADT-I)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ADELE
Last Name:WHITELEY
Suffix:
Gender:
Credentials:RADT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 TEEGARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-4541
Mailing Address - Country:US
Mailing Address - Phone:530-674-4530
Mailing Address - Fax:530-674-4544
Practice Address - Street 1:2 9TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5362
Practice Address - Country:US
Practice Address - Phone:530-742-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03-067230OtherCAS