Provider Demographics
NPI:1093017329
Name:WHITTLE, DEIDRE W (DEIDRE WHITTLE, LPC)
Entity Type:Individual
Prefix:
First Name:DEIDRE
Middle Name:W
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:DEIDRE WHITTLE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16007 HENRY FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-2952
Mailing Address - Country:US
Mailing Address - Phone:804-402-1611
Mailing Address - Fax:804-883-6443
Practice Address - Street 1:16007 HENRY FOREST WAY
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2952
Practice Address - Country:US
Practice Address - Phone:804-402-1611
Practice Address - Fax:804-883-6443
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004950101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional