Provider Demographics
NPI:1093994543
Name:WHITED, LANA SUE
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:SUE
Last Name:WHITED
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LANA
Other - Middle Name:SUE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6801 31ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3007
Mailing Address - Country:US
Mailing Address - Phone:727-345-1481
Mailing Address - Fax:
Practice Address - Street 1:4425 PARK BLVD
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3540
Practice Address - Country:US
Practice Address - Phone:727-235-3429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6672101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor