Healthcare Provider Details

I. General information

NPI: 1922309947
Provider Name (Legal Business Name): ALYSIA MARIE DENDRINOS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALYSIA MARIE NAWROCKI LMSW

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

201 SHELDON BLVD SE
GRAND RAPIDS MI
49503-4513
US

V. Phone/Fax

Practice location:
  • Phone: 616-566-1021
  • Fax:
Mailing address:
  • Phone: 616-459-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090191
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: