Provider Demographics
NPI:1013175462
Name:WHITEHEAD, ELIZABETH ANN (MA, LCPC, RN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MA, LCPC, RN
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCPC, RN
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:TALBOTT
Mailing Address - State:TN
Mailing Address - Zip Code:37877-0421
Mailing Address - Country:US
Mailing Address - Phone:708-710-2488
Mailing Address - Fax:
Practice Address - Street 1:5049 COTTONSEED WAY
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:708-710-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004723101YP2500X
IL041-223157163WP0808X
IL180.013196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health