Provider Demographics
NPI:1982931408
Name:WHITEHEAD, ELBERT
Entity Type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:
Other - Prefix:MISS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:WHITEHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3985 S BROWNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8961
Mailing Address - Country:US
Mailing Address - Phone:252-442-7323
Mailing Address - Fax:
Practice Address - Street 1:150 N. FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:ROCK MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8961
Practice Address - Country:US
Practice Address - Phone:252-442-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health