Provider Demographics
NPI:1568493906
Name:WHITED, WILLIE WALTER (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:WALTER
Last Name:WHITED
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 ADAMS DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-3626
Mailing Address - Country:US
Mailing Address - Phone:404-344-3552
Mailing Address - Fax:404-344-4275
Practice Address - Street 1:1650 ADAMS DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3626
Practice Address - Country:US
Practice Address - Phone:678-772-5677
Practice Address - Fax:404-344-4275
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0025411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical