Provider Demographics
NPI:1528452851
Name:WHITEHEAD, CARMELLA (LMFT)
Entity type:Individual
Prefix:
First Name:CARMELLA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 FAIRVIEW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3354
Mailing Address - Country:US
Mailing Address - Phone:646-530-0993
Mailing Address - Fax:
Practice Address - Street 1:3541 COTILLION AVE.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210
Practice Address - Country:US
Practice Address - Phone:646-530-0993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC106H00000XOtherBLUE CROSS BLUE SHEILD NORTH CAROLINA PPO