Healthcare Provider Details

I. General information

NPI: 1285996660
Provider Name (Legal Business Name): AUSHA WHITEHEAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POHL PL
FORT BRAGG NC
28307-1608
US

IV. Provider business mailing address

20 POHL PL
FORT BRAGG NC
28307-1608
US

V. Phone/Fax

Practice location:
  • Phone: 910-818-7171
  • Fax:
Mailing address:
  • Phone: 910-818-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079469
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: