Provider Demographics
NPI:1598520744
Name:WHITEHEAD'S REFLECTIVE IMAGE COUNSELING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:WHITEHEAD'S REFLECTIVE IMAGE COUNSELING & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-788-8597
Mailing Address - Street 1:5707 CALVERTON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1780
Mailing Address - Country:US
Mailing Address - Phone:410-788-8597
Mailing Address - Fax:
Practice Address - Street 1:5707 CALVERTON ST STE 1A
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1780
Practice Address - Country:US
Practice Address - Phone:410-788-8597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty