Provider Demographics
NPI:1679207823
Name:WHIMS, JACQUELINE ANNISA (LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANNISA
Last Name:WHIMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S LANSING ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1917
Mailing Address - Country:US
Mailing Address - Phone:517-930-3071
Mailing Address - Fax:517-247-2842
Practice Address - Street 1:923 S LANSING ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1917
Practice Address - Country:US
Practice Address - Phone:517-930-3071
Practice Address - Fax:517-247-2842
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401224496101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional