Healthcare Provider Details

I. General information

NPI: 1710584628
Provider Name (Legal Business Name): CATHERINE LESLIE WHITTAKER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 10/04/2020
Certification Date: 10/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 TRAFORD LN
SPRINGFIELD VA
22152-1663
US

IV. Provider business mailing address

12848 MILL HOUSE CT
WOODBRIDGE VA
22192-2927
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8731
  • Fax:
Mailing address:
  • Phone: 703-853-2780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: