Healthcare Provider Details

I. General information

NPI: 1144644295
Provider Name (Legal Business Name): CATHERINE JEAN WITHEROW LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 S RAISINVILLE RD
MONROE MI
48161-9754
US

IV. Provider business mailing address

3311 BURBANK DR
ANN ARBOR MI
48105-1514
US

V. Phone/Fax

Practice location:
  • Phone: 734-384-8876
  • Fax: 734-243-5564
Mailing address:
  • Phone: 734-657-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-01925
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680107611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: