| Disclosures Llc | |
|
2017 College Ave Se Grand Rapids MI 49507-3101 | |
| (616) 634-3301 | |
| (616) 333-7747 |
| Full Name | Disclosures Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2017 College Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Jamie Lee Dalton (OWNER / CEO) |
| Authorized Official Contact | 6166343301 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Disclosures Llc 2017 College Ave Se Grand Rapids MI 49507-3101 Ph: (616) 634-3301 | Disclosures Llc 2017 College Ave Se Grand Rapids MI 49507-3101 Ph: (616) 634-3301 |
| NPI Number | 1669037685 |
|---|---|
| Provider Enumeration Date | 05/06/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669037685 | NPI | - | NPPES |
| 8611393 | Medicaid | MI | |
| 0965761 | Other | MI | BCBSM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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