Provider Demographics
NPI:1376931907
Name:WHITEHEAD, TEJUANDA SHANTA SR (MPA,BSW)
Entity Type:Individual
Prefix:
First Name:TEJUANDA
Middle Name:SHANTA
Last Name:WHITEHEAD
Suffix:SR
Gender:F
Credentials:MPA,BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-5707
Mailing Address - Country:US
Mailing Address - Phone:229-364-9026
Mailing Address - Fax:
Practice Address - Street 1:217 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-5707
Practice Address - Country:US
Practice Address - Phone:229-364-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053681248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker