Provider Demographics
NPI:1033446281
Name:THE WHITTLE GROUP
Entity type:Organization
Organization Name:THE WHITTLE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, QMHP
Authorized Official - Phone:804-402-1611
Mailing Address - Street 1:2012 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4526
Mailing Address - Country:US
Mailing Address - Phone:804-402-1611
Mailing Address - Fax:804-308-1499
Practice Address - Street 1:2012 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4526
Practice Address - Country:US
Practice Address - Phone:804-402-1611
Practice Address - Fax:804-308-1499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002062251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health