Healthcare Provider Details

I. General information

NPI: 1598520744
Provider Name (Legal Business Name): WHITEHEAD'S REFLECTIVE IMAGE COUNSELING & CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
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:
Mailing address:
  • Phone: 443-240-4479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY C WHITEHEAD
Title or Position: CEO/OWNER
Credential: LCPC
Phone: 443-240-4479