Provider Demographics
NPI:1841820776
Name:WHITFIELD, JUDGE V (LCDC)
Entity type:Individual
Prefix:MR
First Name:JUDGE
Middle Name:
Last Name:WHITFIELD
Suffix:V
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 LEXINGTON LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3765
Mailing Address - Country:US
Mailing Address - Phone:214-280-4582
Mailing Address - Fax:
Practice Address - Street 1:1117 LEXINGTON LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3765
Practice Address - Country:US
Practice Address - Phone:214-280-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14768101YA0400X
TX84394101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty