Healthcare Provider Details

I. General information

NPI: 1003425588
Provider Name (Legal Business Name): PATRICE M WOLINSKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7274 DIXIE HWY
BRIDGEPORT MI
48722-9702
US

IV. Provider business mailing address

PO BOX 546
BRIDGEPORT MI
48722-0546
US

V. Phone/Fax

Practice location:
  • Phone: 989-771-7070
  • Fax:
Mailing address:
  • Phone: 989-771-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018479
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401018479
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: