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General NPI Number Information
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NPI Number | 1245509827
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Entity Type | Individual
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Provider Name | MATTHEW DEAN WHITIS LCSW, MAC
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Gender | Male
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BLVD BLDG 9250
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City | FORT MOORE
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State | GA
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Zip | 31905-2102
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Country | US
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Telephone | 706-545-5244
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 DONNA SUE DR
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City | COLUMBUS
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State | GA
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Zip | 31907-1789
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Country | US
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Telephone | 614-286-4285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9810
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License Number State | SC
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