Provider Demographics
NPI:1972345437
Name:WHITEHEAD, ASHLEY MERCEDES (MFT)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:MERCEDES
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GROUPER CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4837
Mailing Address - Country:US
Mailing Address - Phone:863-657-5122
Mailing Address - Fax:
Practice Address - Street 1:230 GROUPER CT
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4837
Practice Address - Country:US
Practice Address - Phone:863-657-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program