Provider Demographics
NPI:1629746581
Name:WITHERSPOON, AJEE GABRIELLE (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:AJEE
Middle Name:GABRIELLE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37426 FOUNTAIN PARK CIR APT 363
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-5647
Mailing Address - Country:US
Mailing Address - Phone:734-658-9019
Mailing Address - Fax:
Practice Address - Street 1:461 W HURON ST STE 107
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1601
Practice Address - Country:US
Practice Address - Phone:248-724-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker