Provider Demographics
NPI:1548515455
Name:WHITFORD, MICHELLE M (LISW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:WHITFORD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 PEBBLE BROOKE TRL
Mailing Address - Street 2:APT 2
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4535
Mailing Address - Country:US
Mailing Address - Phone:513-947-7000
Mailing Address - Fax:513-947-7050
Practice Address - Street 1:43 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-1993
Practice Address - Country:US
Practice Address - Phone:513-947-7000
Practice Address - Fax:513-947-7050
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.09002581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical