Healthcare Provider Details

I. General information

NPI: 1225245517
Provider Name (Legal Business Name): CATHERINE ANNE VANDEWEGE LMSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 SYLVAN AVE SE
GRAND RAPIDS MI
49506-5253
US

IV. Provider business mailing address

2250 SYLVAN AVE SE
GRAND RAPIDS MI
49506-5253
US

V. Phone/Fax

Practice location:
  • Phone: 616-574-4098
  • Fax:
Mailing address:
  • Phone: 616-574-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801086218
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-02097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: