Provider Demographics
NPI:1851129027
Name:WHITEHEAD, JEANINE (LMSW-19948)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LMSW-19948
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 W GUADALUPE RD UNIT 290
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-7738
Mailing Address - Country:US
Mailing Address - Phone:520-236-8283
Mailing Address - Fax:
Practice Address - Street 1:1001 N CENTRAL AVE STE 610
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1935
Practice Address - Country:US
Practice Address - Phone:623-210-6199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical