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General NPI Number Information
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NPI Number | 1548704224
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Entity Type | Organization
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Legal Business Name | CYNTHIA WHITAKER, LCSW
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Dates
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Enumeration Date | 12/14/2016
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Last Update Date | 12/14/2016
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Provider Practice Location Address
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Address Line | 916 N GADSDEN ST
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City | TALLAHASSEE
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State | FL
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Zip | 32303-6316
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Country | US
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Telephone | 850-694-8454
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Fax |
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Provider Business Mailing Address
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Address Line | 2141 SAND DUNE CT
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4872
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Country | US
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Telephone | 850-510-1713
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | CYNTHIA SMITH WHITAKER
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Credential | LCSW 9161
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Telephone | 850-694-8454
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9161
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License Number State | FL
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