Healthcare Provider Details

I. General information

NPI: 1912278433
Provider Name (Legal Business Name): LISA MARIE ALFRIEND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4597
US

IV. Provider business mailing address

DEPT 781625
DETROIT MI
48278-1625
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-3909
  • Fax: 616-336-8830
Mailing address:
  • Phone: 614-355-8004
  • Fax: 614-355-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI1700506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: