Healthcare Provider Details

I. General information

NPI: 1194632505
Provider Name (Legal Business Name): LONNEL LAMONT WHITEHEAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 Q ST SW APT 2
WASHINGTON DC
20024-3406
US

IV. Provider business mailing address

109 FRANKLIN ST NE APT E11
WASHINGTON DC
20002-1066
US

V. Phone/Fax

Practice location:
  • Phone: 240-286-3403
  • Fax:
Mailing address:
  • Phone: 240-286-3403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: