Healthcare Provider Details

I. General information

NPI: 1942005996
Provider Name (Legal Business Name): NINA MARIE BRINKLEY LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

IV. Provider business mailing address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

V. Phone/Fax

Practice location:
  • Phone: 616-379-1131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851117065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: