Healthcare Provider Details

I. General information

NPI: 1083576367
Provider Name (Legal Business Name): MATTHEW DEWIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 11/25/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 ROBINSON RD SE STE 218
GRAND RAPIDS MI
49506-1780
US

IV. Provider business mailing address

1335 CALVIN AVE SE
GRAND RAPIDS MI
49506-3211
US

V. Phone/Fax

Practice location:
  • Phone: 269-806-5719
  • Fax:
Mailing address:
  • Phone: 269-806-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: