MEDICARE: THOMAS JOSEPH WHITELEATHER LCPC, LCADC

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	101YP2500X	Professional Counselor	LC8638	MD

General Provider Information

NPI Number	:	1154774834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS JOSEPH WHITELEATHER LCPC, LCADC

Provider Business Mailing Address
First Line	:	PO BOX 837
Second Line	:
City	:	FOREST HILL
State	:	MD
Zip	:	21050-0837
Country	:	US
Telephone Number	:	410-638-5168
Fax Number	:	410-638-5730

Provider Business Practice Location Address
First Line	:	37 E LEE ST
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-3528
Country	:	US
Telephone Number	:	410-638-5168
Fax Number	:	410-638-5730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2016
Last Update Date	:	01/29/2020

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