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Individual

AKETRE WHITAKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
526 COKER TOWN RD, WHITAKERS, NC 27891-8942
(252) 228-5852
Mailing address
408 SANDERS DR, ROCKY MOUNT, NC 27801-7839

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
251C00000X
Developmentally Disabled Services Day Training Agency
251S00000X
Community/Behavioral Health Agency

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1108090325
PRIVATE
05
110809325
NC
Enumeration date
08/09/2020
Last updated
08/18/2020
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