Provider Demographics
NPI:1124772413
Name:WHITTLESAY, MARC DANIEL JR (LMHC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:DANIEL
Last Name:WHITTLESAY
Suffix:JR
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5897 LITTLE LEAF CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-3501
Mailing Address - Country:US
Mailing Address - Phone:850-490-7829
Mailing Address - Fax:
Practice Address - Street 1:5897 LITTLE LEAF CT
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-3501
Practice Address - Country:US
Practice Address - Phone:850-490-7829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health