Provider Demographics
NPI:1063645802
Name:WHITLEY, CELICA (MSW)
Entity Type:Individual
Prefix:MS
First Name:CELICA
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37570 DALE DR
Mailing Address - Street 2:#303
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7520
Mailing Address - Country:US
Mailing Address - Phone:313-522-1963
Mailing Address - Fax:
Practice Address - Street 1:15004 3RD ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3718
Practice Address - Country:US
Practice Address - Phone:313-868-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010889031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical