Provider Demographics
NPI:1255463907
Name:WHITFIELD, JEAN PEARCE (MS, LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:PEARCE
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:MS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 LEEDS PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-5438
Mailing Address - Country:US
Mailing Address - Phone:919-846-6192
Mailing Address - Fax:
Practice Address - Street 1:115 MARKET ST STE 201
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3241
Practice Address - Country:US
Practice Address - Phone:919-560-5600
Practice Address - Fax:919-560-3018
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0011181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical