Provider Demographics
NPI:1639814098
Name:WHITEHEAD, CHRISTOPHER RONNIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RONNIE
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7925
Mailing Address - Country:US
Mailing Address - Phone:803-414-1999
Mailing Address - Fax:
Practice Address - Street 1:3600 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4052
Practice Address - Country:US
Practice Address - Phone:803-414-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker