Provider Demographics
NPI:1568043842
Name:WHATMORE, GEORGIE
Entity Type:Individual
Prefix:
First Name:GEORGIE
Middle Name:
Last Name:WHATMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S PITT ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3112
Mailing Address - Country:US
Mailing Address - Phone:305-775-0733
Mailing Address - Fax:
Practice Address - Street 1:128 E ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301-2326
Practice Address - Country:US
Practice Address - Phone:305-775-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-18
Last Update Date:2021-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
6535577OtherAMERICAN COUNSELING ASSOCIATION MEMBER ID
418662084OtherAMERICAN COUNSELING ASSOCIATION (ACA) LIABILITY INSURANCE POLICY NUMBER