Healthcare Provider Details

I. General information

NPI: 1679207823
Provider Name (Legal Business Name): JACQUELINE ANNISA WHIMS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S LANSING ST
MASON MI
48854-1917
US

IV. Provider business mailing address

923 S LANSING ST
MASON MI
48854-1917
US

V. Phone/Fax

Practice location:
  • Phone: 517-930-3071
  • Fax: 517-247-2842
Mailing address:
  • Phone: 517-930-3071
  • Fax: 517-247-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224496
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: