Provider Demographics
NPI:1255344354
Name:WHITFIELD, JOHN W JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:WHITFIELD
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2179 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2560
Mailing Address - Country:US
Mailing Address - Phone:502-584-8505
Mailing Address - Fax:502-584-6412
Practice Address - Street 1:560B S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2504
Practice Address - Country:US
Practice Address - Phone:502-584-8505
Practice Address - Fax:502-584-6412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical