Provider Demographics
NPI:1083036503
Name:WITHERSPOON, SARITA ADELLE (LLBSW,QMRP)
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:ADELLE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LLBSW,QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19940 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-1926
Mailing Address - Country:US
Mailing Address - Phone:313-586-2781
Mailing Address - Fax:
Practice Address - Street 1:19940 RYAN RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1926
Practice Address - Country:US
Practice Address - Phone:313-586-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802087621104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker