Provider Demographics
NPI:1770605370
Name:WHITEHURST, MARILYN YVONNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:YVONNE
Last Name:WHITEHURST
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 1:3575 MACON RD STE 18
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-8236
Mailing Address - Country:US
Mailing Address - Phone:706-565-5927
Mailing Address - Fax:706-565-8207
Practice Address - Street 1:3575 MACON RD STE 18
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907
Practice Address - Country:US
Practice Address - Phone:706-565-5927
Practice Address - Fax:706-565-8207
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0033481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical