Provider Demographics
NPI:1356011860
Name:IRIE, WHITNEY CHIVONNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:CHIVONNE
Last Name:IRIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:WHITNEY
Other - Middle Name:CHIVONNE
Other - Last Name:SEWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1479 BROCKETT RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1479 BROCKETT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7326
Practice Address - Country:US
Practice Address - Phone:404-625-5427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-16
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health