Provider Demographics
NPI:1578930830
Name:WHITEHEAD, DANEL
Entity Type:Individual
Prefix:
First Name:DANEL
Middle Name:
Last Name:WHITEHEAD
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 1:4217 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36108-5009
Mailing Address - Country:US
Mailing Address - Phone:313-300-0567
Mailing Address - Fax:
Practice Address - Street 1:3630 S PERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36105-2203
Practice Address - Country:US
Practice Address - Phone:334-625-0779
Practice Address - Fax:334-888-8599
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801098446171M00000X
AL5009C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator