Healthcare Provider Details

I. General information

NPI: 1902593601
Provider Name (Legal Business Name): ELIZABETH ANN WOITESHEK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANN GIBNER LMSW

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 COLUMBUS AVE
GRAND HAVEN MI
49417
US

IV. Provider business mailing address

13954 OAK CHAPEL AVE
GRAND HAVEN MI
49417-9152
US

V. Phone/Fax

Practice location:
  • Phone: 616-607-4476
  • Fax: 833-231-4270
Mailing address:
  • Phone: 616-834-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801069023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: