Provider Demographics
NPI:1265214100
Name:WHITNEY, KORENNA NICHOLLE (LLPC)
Entity type:Individual
Prefix:MRS
First Name:KORENNA
Middle Name:NICHOLLE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:MS
Other - First Name:KORENNA
Other - Middle Name:NICHOLLE
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4113 W VAIL LN
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735
Mailing Address - Country:US
Mailing Address - Phone:313-682-0207
Mailing Address - Fax:
Practice Address - Street 1:11899 M 32
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709-9374
Practice Address - Country:US
Practice Address - Phone:989-785-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health