Healthcare Provider Details

I. General information

NPI: 1043936701
Provider Name (Legal Business Name): ALICIA GABRIELLE HINOJOSA LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 THORNAPPLE RIVER DR SE
GRAND RAPIDS MI
49546-9706
US

IV. Provider business mailing address

PO BOX 609
ADA MI
49301-0609
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-6138
  • Fax: 616-259-4214
Mailing address:
  • Phone: 616-327-2405
  • Fax: 616-259-4214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851115166
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: