Healthcare Provider Details

I. General information

NPI: 1124246400
Provider Name (Legal Business Name): DOROTHY C. WHITEHEAD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 PEN LUCY RD
BALTIMORE MD
21229-2841
US

IV. Provider business mailing address

4514 PEN LUCY RD
BALTIMORE MD
21229-2841
US

V. Phone/Fax

Practice location:
  • Phone: 443-240-4479
  • Fax: 410-945-5393
Mailing address:
  • Phone: 443-240-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCO401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: