Provider Demographics
NPI:1255992871
Name:WHITLEY, HANNAH R (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:R
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 ADELAIDE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-9231
Mailing Address - Country:US
Mailing Address - Phone:630-945-7521
Mailing Address - Fax:
Practice Address - Street 1:312 W MILLBROOK RD STE 129
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4398
Practice Address - Country:US
Practice Address - Phone:919-877-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0136991041C0700X
NCC0147511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical