Healthcare Provider Details

I. General information

NPI: 1790178960
Provider Name (Legal Business Name): DARRYL S WEEKLEY LMSW, ACSW, CAADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

IV. Provider business mailing address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-8131
  • Fax: 616-336-2475
Mailing address:
  • Phone: 616-855-8131
  • Fax: 616-336-2475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801065699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: