Provider Demographics
NPI:1558702134
Name:MCGILLICUDDY, WHITNEY NICOLE (AMFT)
Entity type:Individual
Prefix:MISS
First Name:WHITNEY
Middle Name:NICOLE
Last Name:MCGILLICUDDY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E AVENUE K4 STE 104
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4689
Mailing Address - Country:US
Mailing Address - Phone:818-631-8503
Mailing Address - Fax:
Practice Address - Street 1:314 E AVENUE K4 STE 104
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535
Practice Address - Country:US
Practice Address - Phone:818-631-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist