| Doctor Name: | MR. JUSTIN JAMES WHALEY |
| NPI Number: | 1114070901 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, CCAC, TLSW |
| License Number: | |
| Business Practice Address: | 448 Leonard Ave Fairmont, WV - 265543843 |
| Business Phone Number: | 3043667174 |
| Business Fax Number: | 3043667419 |
| Mailing Address: | 448 Leonard Ave, FAIRMONT |
| State: | WV |
| Postal Code: | 265543843 |
| Phone Number: | 3043667174 |
| Fax Number: | 3043667419 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |