Provider Demographics
NPI:1447015847
Name:WHITAKER, CHARONDA NICOLE (LCASA)
Entity type:Individual
Prefix:
First Name:CHARONDA
Middle Name:NICOLE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BEAUMONT OAKS DR APT 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-0307
Mailing Address - Country:US
Mailing Address - Phone:919-703-8901
Mailing Address - Fax:
Practice Address - Street 1:135 BEAUMONT OAKS DR APT 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-0307
Practice Address - Country:US
Practice Address - Phone:919-703-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-29076101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)