Healthcare Provider Details

I. General information

NPI: 1538968151
Provider Name (Legal Business Name): MICAH B ENOCH LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 BURTON ST SE STE 210
GRAND RAPIDS MI
49506-4669
US

IV. Provider business mailing address

945 BEECHWOOD ST NE
GRAND RAPIDS MI
49505-3709
US

V. Phone/Fax

Practice location:
  • Phone: 616-236-3600
  • Fax:
Mailing address:
  • Phone: 616-446-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114723
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: