Healthcare Provider Details

I. General information

NPI: 1083059802
Provider Name (Legal Business Name): KAHANA HARRISON LMSW/CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 COLRAIN ST SW STE 2
GRAND RAPIDS MI
49548-1013
US

IV. Provider business mailing address

3308 DEVONWOOD HLS NE APT C
GRAND RAPIDS MI
49525-6805
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-1479
  • Fax: 616-988-1493
Mailing address:
  • Phone: 616-581-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089095
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: