Provider Demographics
NPI:1164481701
Name:WHITING, WILLIAM DALE SR (MA SW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DALE
Last Name:WHITING
Suffix:SR
Gender:M
Credentials:MA SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3962 WADHAMS RD
Mailing Address - Street 2:
Mailing Address - City:CHINA TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48054
Mailing Address - Country:US
Mailing Address - Phone:810-329-3308
Mailing Address - Fax:
Practice Address - Street 1:1322 N RIVER RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010631601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI743206Medicaid