Provider Demographics
NPI:1396999306
Name:WHITTINGHAM, EDWINA LENORA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:LENORA
Last Name:WHITTINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EDWINA
Other - Middle Name:LENORA
Other - Last Name:KNOX-BETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2530 OLD SALEM CIR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2454
Mailing Address - Country:US
Mailing Address - Phone:770-918-8348
Mailing Address - Fax:
Practice Address - Street 1:1808 OVER LAKE DR SE STE D
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6608
Practice Address - Country:US
Practice Address - Phone:678-213-2194
Practice Address - Fax:678-922-7767
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical