Provider Demographics
NPI:1801168869
Name:WHITTEN, WILLIAM DURWOOD (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DURWOOD
Last Name:WHITTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DURWOOD
Other - Middle Name:
Other - Last Name:WHITTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:10 W MADISON ST
Mailing Address - Street 2:#11
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5239
Mailing Address - Country:US
Mailing Address - Phone:443-438-7863
Mailing Address - Fax:
Practice Address - Street 1:10 W MADISON ST # 11
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5239
Practice Address - Country:US
Practice Address - Phone:443-438-7863
Practice Address - Fax:443-957-9485
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04983103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD052304600Medicaid