Provider Demographics
NPI:1871060301
Name:WHITEHEAD, TAMIKA NICOLE (LCSW, CADC, MAATP)
Entity type:Individual
Prefix:MISS
First Name:TAMIKA
Middle Name:NICOLE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LCSW, CADC, MAATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 S SOUTH SHORE DR APT 5A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-3885
Mailing Address - Country:US
Mailing Address - Phone:773-504-0808
Mailing Address - Fax:
Practice Address - Street 1:2822 EAST 83RD STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617
Practice Address - Country:US
Practice Address - Phone:773-721-7600
Practice Address - Fax:773-721-7618
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490102971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical