Healthcare Provider Details

I. General information

NPI: 1902258882
Provider Name (Legal Business Name): FAITH SHREVE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 WILSON RD
COLOMA MI
49038-9021
US

IV. Provider business mailing address

4950 WILSON RD
COLOMA MI
49038-9021
US

V. Phone/Fax

Practice location:
  • Phone: 269-363-4123
  • Fax:
Mailing address:
  • Phone: 269-363-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801098039
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: