Healthcare Provider Details

I. General information

NPI: 1962444133
Provider Name (Legal Business Name): WILLIAM HOWARD EDWARDS V LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 LAKE EASTBROOK BLVD SE SUITE 146
GRAND RAPIDS MI
49546-5938
US

IV. Provider business mailing address

3501 LAKE EASTBROOK BLVD SE SUITE 146
GRAND RAPIDS MI
49546-5938
US

V. Phone/Fax

Practice location:
  • Phone: 616-821-3386
  • Fax:
Mailing address:
  • Phone: 616-821-3386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: