Provider Demographics
NPI:1942619424
Name:WHIGHAM, SHRYL (PHD, LCPC, LCADC)
Entity Type:Individual
Prefix:DR
First Name:SHRYL
Middle Name:
Last Name:WHIGHAM
Suffix:
Gender:F
Credentials:PHD, LCPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HAMPTON PARK BLVD
Mailing Address - Street 2:CAP PROGRAM/PRINCE GEORGE'S COUNTY HEALTH DEPARTMENT
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3802
Mailing Address - Country:US
Mailing Address - Phone:301-909-6059
Mailing Address - Fax:
Practice Address - Street 1:425 BRIGHTSEAT RD
Practice Address - Street 2:ROOM 150
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4708
Practice Address - Country:US
Practice Address - Phone:301-909-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA276101YA0400X
MDLC1646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)