| Whitley Trauma Recovery & Counseling Pllc | |
|
116 Hendrix Dr Kernersville NC 27284-3016 | |
| (336) 310-4763 | |
| (336) 310-4308 |
| Full Name | Whitley Trauma Recovery & Counseling Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 116 Hendrix Dr, Kernersville, North Carolina |
| Authorized Official Name and Position | Vickie Pearman Whitley (OWNER/MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 3363104763 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whitley Trauma Recovery & Counseling Pllc 116 Hendrix Dr Kernersville NC 27284-3016 Ph: (336) 972-2156 | Whitley Trauma Recovery & Counseling Pllc 116 Hendrix Dr Kernersville NC 27284-3016 Ph: (336) 310-4763 |
| NPI Number | 1841072899 |
|---|---|
| Provider Enumeration Date | 10/16/2023 |
| Last Update Date | 10/16/2023 |
| Certification Date | 10/16/2023 |
| Medicare PECOS PAC ID | 6002263266 |
|---|---|
| Medicare Enrollment ID | O20231109000300 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841072899 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | (* (Not Available)) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | Vickie P Whitley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770963639 PECOS PAC ID: 7517229313 Enrollment ID: I20180314001285 |
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