Provider Demographics
NPI:1972242642
Name:WHITTAKER, JANUARY RAE (CADAC II)
Entity type:Individual
Prefix:MS
First Name:JANUARY
Middle Name:RAE
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-1805
Mailing Address - Country:US
Mailing Address - Phone:812-797-9711
Mailing Address - Fax:
Practice Address - Street 1:508 JACKSON ST # 102
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3128
Practice Address - Country:US
Practice Address - Phone:812-817-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INC2-51294101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)