Healthcare Provider Details

I. General information

NPI: 1710898093
Provider Name (Legal Business Name): WHITNEY SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17520 DOUGLAS RD
SOUTH BEND IN
46635
US

IV. Provider business mailing address

5776 GRAPE RD STE 51
MISHAWAKA IN
46545-8460
US

V. Phone/Fax

Practice location:
  • Phone: 704-228-3756
  • Fax:
Mailing address:
  • Phone: 704-228-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH WHITNEY
Title or Position: OWNER & PSYCHOTHERAPIST
Credential: PHD, LCMHC, LCPC
Phone: 704-228-3756