Provider Demographics
NPI:1023868320
Name:WHITNEY, RICHARD ALVIN SR (APC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALVIN
Last Name:WHITNEY
Suffix:SR
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HENRY HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-3657
Mailing Address - Country:US
Mailing Address - Phone:678-786-6362
Mailing Address - Fax:
Practice Address - Street 1:5109 HIGHWAY 278 NE STE D
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2608
Practice Address - Country:US
Practice Address - Phone:770-787-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor