MEDICARE: DANEL WHITEHEAD

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	1041C0700X	Clinical Social Worker	5009C	AL

General Provider Information

NPI Number	:	1578930830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANEL WHITEHEAD

Provider Business Mailing Address
First Line	:	3066 ZELDA RD PMB 234
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-5009
Country	:	US
Telephone Number	:	334-625-0779
Fax Number	:

Provider Business Practice Location Address
First Line	:	7806 VAUGHN RD # 1074
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-1333
Country	:	US
Telephone Number	:	334-625-0779
Fax Number	:	334-888-8599

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

Provider Enumeration Date	:	08/21/2015
Last Update Date	:	10/15/2024

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Directions to “ DANEL WHITEHEAD ” Practice Location

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