=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184352031
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARLA WHITT LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2022
-----------------------------------------------------
Last Update Date | 08/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 25TH ST N
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35203-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-407-6900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5929 SHILO RUN
-----------------------------------------------------
City | PINSON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35126-3558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 4446C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------