Individual
DEMEITRIUS M WHITEHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.A., CSAC, QMHP-A-C
Contact information
Practice address
12388 WARWICK BLVD STE 302, NEWPORT NEWS, VA 23602, STE 302, NORFOLK, VA 23606-2360
(757) 679-6058
Mailing address
12388 WARWICK BLVD STE 302, NEWPORT NEWS, VA 23606-3858
(757) 679-6058
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0710102215
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
NONE
—
Enumeration date
09/27/2018
Last updated
09/27/2018
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