Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 981010 | OH |
NPI | 1003328063 |
---|---|
Provider Name | Marshon Whitley |
First Address | Akron, OH 44303-1438 |
Second Address | Akron, OH 44303-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2017 |
Last Update Date | 31/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2847709 | (05) | OH |