Healthcare Provider Details

I. General information

NPI: 1184279432
Provider Name (Legal Business Name): NANCY DOCK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 03/07/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

549 MARYLAND AVE NE
GRAND RAPIDS MI
49503-2106
US

IV. Provider business mailing address

549 MARYLAND AVE NE
GRAND RAPIDS MI
49503-2106
US

V. Phone/Fax

Practice location:
  • Phone: 616-334-9334
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NANCY DOCK
Title or Position: SOCIAL WORKER
Credential: LMSW
Phone: 616-334-9334