Provider Demographics
NPI:1609609551
Name:WHITSON, CHANEL DYSHANNA (CPRS,CDCA PRE)
Entity type:Individual
Prefix:
First Name:CHANEL
Middle Name:DYSHANNA
Last Name:WHITSON
Suffix:
Gender:F
Credentials:CPRS,CDCA PRE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-3736
Mailing Address - Country:US
Mailing Address - Phone:216-432-7200
Mailing Address - Fax:
Practice Address - Street 1:4500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3736
Practice Address - Country:US
Practice Address - Phone:216-432-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health