Provider Demographics
NPI:1679233175
Name:WHITFIELD, THOMAS LIDDELL JR
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LIDDELL
Last Name:WHITFIELD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E SOUTH ST UNIT 1029
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3516
Mailing Address - Country:US
Mailing Address - Phone:407-758-1856
Mailing Address - Fax:
Practice Address - Street 1:304 E SOUTH ST UNIT 1029
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3516
Practice Address - Country:US
Practice Address - Phone:407-758-1856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW055530103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth