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General NPI Number Information
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NPI Number | 1457829525
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Entity Type | Individual
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Provider Name | KELLY ANTOINETTE WHITE MHC-P
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Gender | Female
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Dates
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Enumeration Date | 11/07/2018
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 17321 TELEGRAPH RD
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City | DETROIT
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State | MI
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Zip | 48219-3132
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Country | US
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Telephone | 313-531-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 29306 WAGNER DR
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City | WARREN
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State | MI
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Zip | 48093-8629
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Country | US
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Telephone | 716-392-7557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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