Healthcare Provider Details

I. General information

NPI: 1568895340
Provider Name (Legal Business Name): MOLLY KAY DEHOOG LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 PARCHMENT DR SE STE 100
GRAND RAPIDS MI
49546-2307
US

IV. Provider business mailing address

326 EASTMOOR AVE SE
GRAND RAPIDS MI
49546-2227
US

V. Phone/Fax

Practice location:
  • Phone: 616-366-4226
  • Fax:
Mailing address:
  • Phone: 616-581-8505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113894
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: