Provider Demographics
NPI:1932212958
Name:WHITEHEAD, MICHAEL STEPHEN (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHEN
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N EMILY ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1841
Mailing Address - Country:US
Mailing Address - Phone:231-233-0115
Mailing Address - Fax:231-316-5943
Practice Address - Street 1:112 N EMILY ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1841
Practice Address - Country:US
Practice Address - Phone:123-123-3011
Practice Address - Fax:231-316-5943
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010780551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM19900020Medicare ID - Type Unspecified