Provider Demographics
NPI:1972063766
Name:WHITERS, DAVID LEE (PHD, LCSW, MAC, MAT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:WHITERS
Suffix:
Gender:M
Credentials:PHD, LCSW, MAC, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1713
Mailing Address - Country:US
Mailing Address - Phone:404-691-9580
Mailing Address - Fax:
Practice Address - Street 1:2429 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1713
Practice Address - Country:US
Practice Address - Phone:404-691-9580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0066821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty