Provider Demographics
NPI:1912605858
Name:WHITING, DETRA V (LICSW)
Entity Type:Individual
Prefix:
First Name:DETRA
Middle Name:V
Last Name:WHITING
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7806 VAUGHN RD # 1408
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1333
Mailing Address - Country:US
Mailing Address - Phone:256-861-0664
Mailing Address - Fax:
Practice Address - Street 1:2400 PRESIDENTS DR STE 150
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1618
Practice Address - Country:US
Practice Address - Phone:256-861-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker