Provider Demographics
NPI:1952879975
Name:WHITEHEAD, KYLE DAVID (MA, LPCA)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:DAVID
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MA, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7615 COLONY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-0007
Mailing Address - Country:US
Mailing Address - Phone:704-365-4545
Mailing Address - Fax:
Practice Address - Street 1:7615 COLONY RD STE 200
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-0007
Practice Address - Country:US
Practice Address - Phone:704-365-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14438101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional