Provider Demographics
NPI:1124246400
Name:WHITEHEAD, DOROTHY C (PHD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:C
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5707 CALVERTON STREET
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228
Mailing Address - Country:US
Mailing Address - Phone:410-778-8597
Mailing Address - Fax:410-945-5393
Practice Address - Street 1:5707 CALVERTON STREET
Practice Address - Street 2:SUITE #1A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:410-778-8597
Practice Address - Fax:410-945-5393
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCO401101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD699359100Medicaid