Provider Demographics
NPI:1679207823
Name:WHIMS, JACQUELINE ANNISA (LLPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNISA
Last Name:WHIMS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 W HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-9329
Mailing Address - Country:US
Mailing Address - Phone:517-367-0670
Mailing Address - Fax:517-367-0681
Practice Address - Street 1:2950 W HOWELL RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-9329
Practice Address - Country:US
Practice Address - Phone:517-367-0670
Practice Address - Fax:517-367-0681
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022225101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor