Provider Information for 1639520836
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KIRSTIN DAVIS LMSW, LCSW
Sex: Female
NPI: 1639520836
Last Updated: 2024-04-03
Certification Date: 2024-04-03
Certification Date: 2024-04-03
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639520836 | ||||||||
| Enumeration Date | 2016-06-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 300 68TH ST SE GRAND RAPIDS, MI 49548-6927 United States Phone: 616-455-5000 | Fax: | ||||||||
| Primary Practice Address | 300 68TH ST SE GRAND RAPIDS, MI 49548-6927 United States Phone: 616-455-5000 | Fax: | ||||||||
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