Individual
KEISHA NICOLE WHITNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QMHP C, QMHP A, CNA
Contact information
Practice address
201 WYNN ST, PORTSMOUTH, VA 23701-3141
(757) 621-0117
Mailing address
201 WYNN ST, PORTSMOUTH, VA 23701-3141
(757) 621-0117
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0732003734
VA
101YM0800X
Mental Health Counselor
Primary
0733007314
VA
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
376K00000X
Nurse's Aide
1401096837
VA
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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