Provider Demographics
NPI:1801819289
Name:MUDENDA-WHALEY, SYLVIA JOYCE (LPC MHSP NCC)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:JOYCE
Last Name:MUDENDA-WHALEY
Suffix:
Gender:F
Credentials:LPC MHSP NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 CECELIA DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-3216
Mailing Address - Country:US
Mailing Address - Phone:423-855-9947
Mailing Address - Fax:423-553-5686
Practice Address - Street 1:5726 MARLIN RD
Practice Address - Street 2:STE 312
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4008
Practice Address - Country:US
Practice Address - Phone:423-510-0171
Practice Address - Fax:423-553-5686
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001755101YM0800X
TN101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN421619846OtherFEDERAL TAX ID
TN5441063Medicaid