Provider Demographics
NPI:1548388614
Name:THE WHITEHEAD INSTITUTE OF MENTAL HEALTH PROFESSIONALS, P.C.
Entity Type:Organization
Organization Name:THE WHITEHEAD INSTITUTE OF MENTAL HEALTH PROFESSIONALS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST - CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW-C
Authorized Official - Phone:410-766-3366
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:SUTIE 607
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-3366
Mailing Address - Fax:410-787-9879
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:SUTIE 607
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-766-3366
Practice Address - Fax:410-787-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD020651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKK56Medicare ID - Type Unspecified