Provider Demographics
NPI:1457846404
Name:WHITTLESEY, TAMEKA (LCSWA)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:WHITTLESEY
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 RESEARCH DR STE 133
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-8569
Mailing Address - Country:US
Mailing Address - Phone:980-209-3222
Mailing Address - Fax:844-841-1302
Practice Address - Street 1:9700 RESEARCH DR STE 133
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:980-209-3222
Practice Address - Fax:844-841-1302
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0124641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical