Provider Demographics
NPI:1164924940
Name:WHITFIELD, DAVID DOUGLAS
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DOUGLAS
Last Name:WHITFIELD
Suffix:
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 1:114 WOOLRICH DR
Mailing Address - Street 2:
Mailing Address - City:KENLY
Mailing Address - State:NC
Mailing Address - Zip Code:27542-8085
Mailing Address - Country:US
Mailing Address - Phone:919-300-9169
Mailing Address - Fax:919-284-0005
Practice Address - Street 1:114 WOOLRICH DR
Practice Address - Street 2:
Practice Address - City:KENLY
Practice Address - State:NC
Practice Address - Zip Code:27542-8085
Practice Address - Country:US
Practice Address - Phone:919-300-9169
Practice Address - Fax:919-284-0005
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities