Individual
MR. GARY R WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
901 W 3RD ST, FLORA, IL 62839-1287
(618) 662-2871
(618) 662-4748
Mailing address
PO BOX M, 504 MICAH DRIVE, OLNEY, IL 62450-0913
(618) 395-4306
(618) 395-4507
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/23/2010
Last updated
09/23/2010
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