Basic Information
| Provider Information | |||||||||
| NPI: | 1144644295 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITHEROW | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW, CAADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3311 BURBANK DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481051514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346572751 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1001 S RAISINVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481619754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343848876 | ||||||||
| FaxNumber: | 7342435564 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2014 | ||||||||
| LastUpdateDate: | 02/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | C-01925 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 680107611 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.