Healthcare Provider Details

I. General information

NPI: 1730415050
Provider Name (Legal Business Name): DAWN KAY CARPENTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2009
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

781 - 36TH ST., SE HOPE NETWORK DCS
GRAND RAPIDS MI
49501-0141
US

IV. Provider business mailing address

PO BOX 141 HOPE NETWORK DCS
GRAND RAPIDS MI
49501-0141
US

V. Phone/Fax

Practice location:
  • Phone: 616-248-5179
  • Fax: 616-243-2302
Mailing address:
  • Phone: 616-248-5179
  • Fax: 616-243-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801094994
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: