Provider Demographics
NPI:1184763286
Name:WHITAKER, LORITA B (LCSW)
Entity type:Individual
Prefix:
First Name:LORITA
Middle Name:B
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3175
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-3175
Mailing Address - Country:US
Mailing Address - Phone:770-426-6460
Mailing Address - Fax:770-919-1456
Practice Address - Street 1:77 COLE ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2030
Practice Address - Country:US
Practice Address - Phone:770-426-6460
Practice Address - Fax:770-919-1456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBBJCMedicare ID - Type Unspecified