Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003488230 |
---|---|
Provider Name | Mrs. Antoinette Marlene Whitt |
First Address | Maple Heights, OH 44137-4844 |
Second Address | Cleveland, OH 44115-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 16/07/2021 |