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General NPI Number Information
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NPI Number | 1063264190
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Entity Type | Organization
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Legal Business Name | DREW MARTINI LLC
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Dates
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Enumeration Date | 04/02/2024
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Last Update Date | 04/02/2024
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Provider Practice Location Address
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Address Line | 3280 E BELTLINE CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9494
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Country | US
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Telephone | 616-666-3410
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 HAMILTON AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-4218
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Country | US
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Telephone | 586-601-6482
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. DREW KINGSBURY MARTINI
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Credential | LMSW
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Telephone | 586-601-6482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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