Healthcare Provider Details

I. General information

NPI: 1114199502
Provider Name (Legal Business Name): BARBRA THRESSA GUMN-WHITERS MA, LLPC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18284 JAMES COUZENS FWY
DETROIT MI
48235-2503
US

IV. Provider business mailing address

18284 JAMES COUZENS FWY
DETROIT MI
48235-2503
US

V. Phone/Fax

Practice location:
  • Phone: 313-646-6483
  • Fax: 313-646-6578
Mailing address:
  • Phone: 313-646-6483
  • Fax: 313-646-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401010277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: