Provider Demographics
NPI:1518032960
Name:WHITLEY, MICHELLE A (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-6068
Mailing Address - Country:US
Mailing Address - Phone:803-327-6103
Mailing Address - Fax:803-328-5443
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8968
Practice Address - Country:US
Practice Address - Phone:803-327-6103
Practice Address - Fax:803-328-5443
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570629234006OtherBCBS