Provider Demographics
NPI:1154160745
Name:WHITSON, NATHAN CHIVUKULA (MA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHIVUKULA
Last Name:WHITSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 WASHINGTON ST STE 316
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-2568
Mailing Address - Country:US
Mailing Address - Phone:857-273-2123
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST STE 316
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2568
Practice Address - Country:US
Practice Address - Phone:857-273-2123
Practice Address - Fax:888-972-6995
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health