Provider Demographics
NPI:1689043200
Name:HELEN T WHITLEY, LCSW, INC.
Entity Type:Organization
Organization Name:HELEN T WHITLEY, LCSW, INC.
Other - Org Name:HELEN T WHITLEY, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:770-517-3363
Mailing Address - Street 1:131 MIRRAMONT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8215
Mailing Address - Country:US
Mailing Address - Phone:770-517-3363
Mailing Address - Fax:770-517-3308
Practice Address - Street 1:131 MIRRAMONT LAKE DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8215
Practice Address - Country:US
Practice Address - Phone:770-517-3363
Practice Address - Fax:770-517-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1093809220OtherINDIVIDUAL NPI