Provider Demographics
NPI:1427422427
Name:WHITCOME, CARLEE MICHELLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:CARLEE
Middle Name:MICHELLE
Last Name:WHITCOME
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:CARLEE
Other - Middle Name:MICHELLE
Other - Last Name:RUSSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4519 CASCADE RD SE STE 5
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8319
Practice Address - Country:US
Practice Address - Phone:616-228-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-14
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801096984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker