Healthcare Provider Details

I. General information

NPI: 1396227229
Provider Name (Legal Business Name): CHRISTOPHER SCOT DOUCETTE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 AIRWAY ST NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

2064 AIRWAY ST NE
GRAND RAPIDS MI
49525-1502
US

V. Phone/Fax

Practice location:
  • Phone: 616-389-3372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801078560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: