Provider Demographics
NPI:1427879907
Name:WHITTED, LAUREN M
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:M
Last Name:WHITTED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 RAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-9817
Mailing Address - Country:US
Mailing Address - Phone:336-324-1765
Mailing Address - Fax:
Practice Address - Street 1:2212 RAM RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-9817
Practice Address - Country:US
Practice Address - Phone:336-324-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities