MEDICARE: THE WHITTLE GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	0701002062	VA

General Provider Information

NPI Number	:	1033446281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WHITTLE GROUP

Provider Business Mailing Address
First Line	:	2012 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4526
Country	:	US
Telephone Number	:	804-402-1611
Fax Number	:	804-308-1499

Provider Business Practice Location Address
First Line	:	2012 W MAIN ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-4526
Country	:	US
Telephone Number	:	804-402-1611
Fax Number	:	804-308-1499

Authorized Official
Title or Position	:	CEO/PROGRAM DIRECTOR
Name	:	DEIDRE W. WHITTLE
Credential	:	M.ED, QMHP
Telephone Number	:	804-402-1611

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/09/2009

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Directions to “THE WHITTLE GROUP ” Practice Location

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