Individual
THOMAS WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13669 HORNET WAY APT 402, WOODBRIDGE, VA 22191-5232
(703) 203-1699
Mailing address
13669 HORNET WAY APT 402, WOODBRIDGE, VA 22191-5232
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
133N00000X
Nutritionist
Primary
—
—
133NN1002X
Nutrition Education Nutritionist
—
—
Other
Enumeration date
06/24/2017
Last updated
06/24/2017
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