Provider Demographics
NPI:1982756508
Name:WHITMORE, DARLENE K
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:K
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:K
Other - Last Name:WALDEN JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2238 E GINTER ROAD
Mailing Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706
Mailing Address - Country:US
Mailing Address - Phone:520-545-1237
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:2238 E GINTER ROAD
Practice Address - Street 2:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO 12
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706
Practice Address - Country:US
Practice Address - Phone:520-545-1237
Practice Address - Fax:520-545-2120
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ814401Medicaid