Provider Demographics
NPI:1548776255
Name:WHITAKER, RACHELLE (LPC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 24 MILE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3005
Mailing Address - Country:US
Mailing Address - Phone:248-310-9947
Mailing Address - Fax:
Practice Address - Street 1:4501 24 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3005
Practice Address - Country:US
Practice Address - Phone:248-310-9947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016012101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional