Healthcare Provider Details

I. General information

NPI: 1780394460
Provider Name (Legal Business Name): KARA PETTINGER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KENMOOR AVE SE STE 103
GRAND RAPIDS MI
49546-8626
US

IV. Provider business mailing address

5741 DORADO CT NE
ROCKFORD MI
49341-8335
US

V. Phone/Fax

Practice location:
  • Phone: 517-983-3384
  • Fax:
Mailing address:
  • Phone: 517-983-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARA M PETTINGER
Title or Position: OWNER/THERAPIST
Credential: LMSW
Phone: 517-983-3384