Healthcare Provider Details

I. General information

NPI: 1518380666
Provider Name (Legal Business Name): LEGACY MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13741 PEARSON ST
OAK PARK MI
48237-2761
US

IV. Provider business mailing address

13741 PEARSON ST
OAK PARK MI
48237-2761
US

V. Phone/Fax

Practice location:
  • Phone: 248-506-9344
  • Fax:
Mailing address:
  • Phone: 248-506-9344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number630104388
License Number StateMI

VIII. Authorized Official

Name: DR. CHARMEKA WHITEHEAD
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 248-506-9344