Healthcare Provider Details

I. General information

NPI: 1649900689
Provider Name (Legal Business Name): GABRIELLE GRACE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4597
US

IV. Provider business mailing address

344 HAYMAC DR
KALAMAZOO MI
49004-1770
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax: 616-336-8830
Mailing address:
  • Phone: 616-828-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851114577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: