Healthcare Provider Details

I. General information

NPI: 1003589565
Provider Name (Legal Business Name): AMANDA JOY REWA MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 EVERGREEN DR NE STE 210
GRAND RAPIDS MI
49525-9830
US

IV. Provider business mailing address

400 SPAULDING HILLS CIR SE APT 205
ADA MI
49301-7920
US

V. Phone/Fax

Practice location:
  • Phone: 231-577-8284
  • Fax:
Mailing address:
  • Phone: 231-577-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401224706
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: