Gwendolyn Lenette Pettway, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

64010062571 Issued in MI

Practice address

5901 Cadieux Rd
Detroit, MI 48224-2003

Phone

(313) 683-5330

NPI assigned

May 17, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fresh Beginnings Counseling Services

  • Mental Health Counselor
  • Detroit, MI
  • NPI 1962195891
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684886400000",
    "number": "1932492485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5901 CADIEUX RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242003",
            "telephone_number": "313-683-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5901 CADIEUX RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482242003",
            "telephone_number": "313-683-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTWAY",
        "first_name": "GWENDOLYN",
        "middle_name": "LENETTE",
        "name_prefix": "Dr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-17",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MI",
            "license": "64010062571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Pettis
• Willie James Pettiway Sr., MD
• Joyya Pettus, CERTIFIED PEER SPEC
• Barbara Anne Pettway
• Carl Pettway Jr., LLMSW
• Nicole Theodora Pettway, LPN
• Sheena Petty
• Cynthia Pfeiffer, M.D.
• Laura A Pfeiffer, NP
• Jacqueline Marie Pflaum-Carlson, M.D.

• Mental Health Counselor in Detroit, MI
• Providers in Detroit, MI by specialty
• Mental Health Counselor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.