Healthcare Provider Details

I. General information

NPI: 1699898478
Provider Name (Legal Business Name): VIRGINIA SCHOLTEN MSW LMSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCADE AVE SE STE #4481
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

4467 CASCADE AVE SE STE #4481
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-745-4426
  • Fax: 616-361-2819
Mailing address:
  • Phone: 616-745-4426
  • Fax: 616-361-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069881
License Number StateMI

VIII. Authorized Official

Name: VIRGINIA RUTH SCHOLTEN
Title or Position: OWNER SOLE PROPRIETER
Credential:
Phone: 616-745-4426