Provider Demographics
NPI:1750755658
Name:WHITEHEAD, TATNAI (MA)
Entity type:Individual
Prefix:MS
First Name:TATNAI
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3792 SHENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-7155
Mailing Address - Country:US
Mailing Address - Phone:404-304-2228
Mailing Address - Fax:
Practice Address - Street 1:3792 SHENFIELD DR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-7155
Practice Address - Country:US
Practice Address - Phone:404-304-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15108309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health