Individual
MS. DE'AUDRA JACKSON WHITING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
402 SAGEBRUSH LN, MAGNOLIA, TX 77354-1736
(832) 659-1224
Mailing address
402 SAGEBRUSH LN, MAGNOLIA, TX 77354-1736
(832) 659-1224
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
9347
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9347
LICENSED CHEMICAL DEPENDENCY COUNSELOR
TX
Enumeration date
07/25/2011
Last updated
07/25/2011
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