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Edward John Whitacre

Social Worker

Behavioral Health & Social Service Providers

11825 Rock Landing Dr, The James Building, Newport News, VA 23606-4236

PECOS Enrollment

This provider is enrolled in PECOS as EDWARD WHITACRE.

Based on the most recent information from CMS, provider Edward John Whitacre is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1417965583
Provider Type
Individual
Full Name
Whitacre, Edward John
Title
Mr.
Credential
LCSW

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/4/2006
Last Updated
7/8/2007

Contact Information

Practice Location

11825 Rock Landing Dr, The James Building, Newport News, VA 23606-4236

(757) 873-1736

(757) 873-1028

Mailing Location

4657 Massena Dr, Williamsburg, VA 23188-1261

(757) 566-4824

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 0904002390 Virginia

Edward John Whitacre

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

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Code

Description

License

Code

Description

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