Basic Information
| Provider Information | |||||||||
| NPI: | 1689209827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITHED | ||||||||
| FirstName: | ANNMARIE | ||||||||
| MiddleName: | TERESE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 538622 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303538622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Practice Location | |||||||||
| Address1: | 5530 NORTHROP RD | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325708701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107429243 | ||||||||
| FaxNumber: | 8887461787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2020 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY10745 | FL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.