Individual
DOMINICKA WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS
Contact information
Practice address
12365 BLUESTEM LN., CHARLOTTE, NC 28277
(201) 540-6512
Mailing address
12365 BLUESTEM LN, CHARLOTTE, NC 28277-1700
(201) 540-6512
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-23562
NC
Other
Enumeration date
06/08/2017
Last updated
03/20/2023
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