Provider Demographics
NPI:1710534094
Name:WHIT, MALIK
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:
Last Name:WHIT
Suffix:
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 1:2411 E ILLIANA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5764
Mailing Address - Country:US
Mailing Address - Phone:786-564-3491
Mailing Address - Fax:
Practice Address - Street 1:2154 CENTRAL FLORIDA PKWY STE B2
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8986
Practice Address - Country:US
Practice Address - Phone:636-368-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician