Healthcare Provider Details

I. General information

NPI: 1760032973
Provider Name (Legal Business Name): CAROLYN WHITAKER DEWINE MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 EASTLOOK DR
SALINE MI
48176-1578
US

IV. Provider business mailing address

617 EASTLOOK DR
SALINE MI
48176-1578
US

V. Phone/Fax

Practice location:
  • Phone: 734-478-4559
  • Fax:
Mailing address:
  • Phone: 734-478-4559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6361007870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: