Provider Demographics
NPI:1982752986
Name:WHITELEY, MARY JANE (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:WHITELEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 RADCLIFFE ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-5112
Mailing Address - Country:US
Mailing Address - Phone:215-781-0161
Mailing Address - Fax:
Practice Address - Street 1:4 CORNERSTONE DRIVE
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-757-6916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional