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General NPI Number Information
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NPI Number | 1861823825
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Entity Type | Individual
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Provider Name | KENEESHA WHITEHEAD PHD, LPC
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Gender | Female
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 3131 S STATE ST STE 226
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City | ANN ARBOR
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State | MI
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Zip | 48108-1658
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Country | US
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Telephone | 734-430-0881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1952
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City | TAYLOR
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State | MI
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Zip | 48180-8852
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Country | US
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Telephone | 734-430-0881
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401019372
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License Number State | MI
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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 | 6401010376
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401019372
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License Number State | MI
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