Healthcare Provider Details

I. General information

NPI: 1851696447
Provider Name (Legal Business Name): WILLIAM JAMES WEITZEL LMSW ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2011
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4467 CASCADE RD SE SUITE 4467
GRAND RAPIDS MI
49546-3776
US

IV. Provider business mailing address

3396 HIDDEN HILLS AVE SE
GRAND RAPIDS MI
49546-9125
US

V. Phone/Fax

Practice location:
  • Phone: 616-446-1873
  • Fax:
Mailing address:
  • Phone: 616-446-1873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801011410
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: