Healthcare Provider Details

I. General information

NPI: 1396081253
Provider Name (Legal Business Name): WILLIAM C PADDING, LMSW, ACSW, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW SUITE 101
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

640 3 MILE RD NW SUITE 101
GRAND RAPIDS MI
49544-8209
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8900
  • Fax: 616-785-8900
Mailing address:
  • Phone: 616-785-8900
  • Fax: 616-785-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801063266
License Number StateMI

VIII. Authorized Official

Name: MR. WILLIAM C PADDING
Title or Position: PRESIDENT
Credential: LMSW
Phone: 616-785-8900