Provider Demographics
NPI:1447872874
Name:WHITEHEAD, TERESA DELORIS (BHT, MS,)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DELORIS
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:BHT, MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14573 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-2818
Mailing Address - Country:US
Mailing Address - Phone:609-752-5677
Mailing Address - Fax:
Practice Address - Street 1:14573 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-2818
Practice Address - Country:US
Practice Address - Phone:609-752-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)