Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 101YM0800X | Mental Health Counselor | ||
N | 101YP1600X | Pastoral Counselor | ||
N | 101YS0200X | School Counselor |
NPI | 1043973738 |
---|---|
Provider Name | Shantell Whitaker |
First Address | Jacksonville, FL 32244-4990 |
Second Address | Jacksonville, FL 32244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2021 |
Last Update Date | 19/10/2021 |