Provider Demographics
NPI:1013269588
Name:ELY WHITFIELD, LYNNETTE MARIE (LLPC)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:MARIE
Last Name:ELY WHITFIELD
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:PO BOX 40214
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-0214
Mailing Address - Country:US
Mailing Address - Phone:313-207-9347
Mailing Address - Fax:
Practice Address - Street 1:17200 SNOWDEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-4148
Practice Address - Country:US
Practice Address - Phone:313-207-9347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health