Provider Demographics
NPI:1003490723
Name:WHITEHEAD, DAVID EUGENE JR
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EUGENE
Last Name:WHITEHEAD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 FOS AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2715
Mailing Address - Country:US
Mailing Address - Phone:941-724-4009
Mailing Address - Fax:
Practice Address - Street 1:2550 BELLE CHASSE HWY STE 150
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-6733
Practice Address - Country:US
Practice Address - Phone:504-362-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service