Provider Demographics
NPI:1578304333
Name:WHITEHEAD, DARRIS LAMONT (MSW, LMSW)
Entity type:Individual
Prefix:MR
First Name:DARRIS
Middle Name:LAMONT
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 LACLEDE AVE
Mailing Address - Street 2:CWE THERAPY SUITE
Mailing Address - City:SAINT LOUIS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63108
Mailing Address - Country:US
Mailing Address - Phone:314-494-5288
Mailing Address - Fax:
Practice Address - Street 1:4307 LACLEDE AVE
Practice Address - Street 2:CWE THERAPY SUITE
Practice Address - City:SAINT LOUIS CITY
Practice Address - State:MO
Practice Address - Zip Code:63108
Practice Address - Country:US
Practice Address - Phone:314-494-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022042642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker