Individual
SHELLEY JEAN WHITEMAN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-ADVANCED
Contact information
Practice address
190 MAIN ST, TUPPER LAKE, NY 12986-1018
(518) 359-5401
(518) 359-5401
Mailing address
190 MAIN ST, TUPPER LAKE, NY 12986-1018
(518) 359-5401
(518) 359-5401
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12637
NY
Other
Enumeration date
01/04/2022
Last updated
01/04/2022
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