Provider Demographics
NPI:1902187628
Name:WHITNEY, MARTHA L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 JOHN MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-4518
Mailing Address - Country:US
Mailing Address - Phone:540-631-0999
Mailing Address - Fax:276-794-7965
Practice Address - Street 1:904 JOHN MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-4518
Practice Address - Country:US
Practice Address - Phone:540-631-0999
Practice Address - Fax:276-794-7965
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717000975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902187628Medicaid