Provider Demographics
NPI:1679862015
Name:WHITTINGHAM, MERLENE
Entity Type:Individual
Prefix:
First Name:MERLENE
Middle Name:
Last Name:WHITTINGHAM
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 1:2196 WHITE PINE CIR
Mailing Address - Street 2:UNIT C
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6173
Mailing Address - Country:US
Mailing Address - Phone:561-667-2904
Mailing Address - Fax:
Practice Address - Street 1:2196 WHITE PINE CIR
Practice Address - Street 2:UNIT C
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-6173
Practice Address - Country:US
Practice Address - Phone:561-667-2904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103T00000XBehavioral Health & Social Service ProvidersPsychologist