MEDICARE: MINNIE WHITEHEAD LCSW

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1386108561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINNIE WHITEHEAD LCSW

Provider Business Mailing Address
First Line	:	3612 GATEWAY DR APT 2B
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-5062
Country	:	US
Telephone Number	:	757-234-5888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 OLD GREENBRIER RD STE 102
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2649
Country	:	US
Telephone Number	:	757-790-5916
Fax Number	:

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

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	01/22/2019

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Directions to “ MINNIE WHITEHEAD LCSW” Practice Location

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