Provider Demographics
NPI:1053822296
Name:WHITFIELD, BRENDA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:WHITFIELD
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 1:2000 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2002
Mailing Address - Country:US
Mailing Address - Phone:318-222-8511
Mailing Address - Fax:
Practice Address - Street 1:40733 HIGHWAY 45 S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9636
Practice Address - Country:US
Practice Address - Phone:318-617-2498
Practice Address - Fax:337-855-1829
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional