Provider Demographics
NPI:1558867887
Name:WHITEHEAD, KORLETT Y (MSW LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:KORLETT
Middle Name:Y
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MSW LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 CLOCKTOWER LN APT 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3115
Mailing Address - Country:US
Mailing Address - Phone:443-800-0820
Mailing Address - Fax:
Practice Address - Street 1:6700 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2105
Practice Address - Country:US
Practice Address - Phone:443-800-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD899013100Medicaid
MDEQ13-0000OtherCAREFIRST