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General NPI Number Information
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NPI Number | 1083576367
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Entity Type | Individual
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Provider Name | MATTHEW DEWIT
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Gender | Male
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 1430 ROBINSON RD SE STE 218
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1780
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Country | US
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Telephone | 269-806-5719
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 CALVIN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-3211
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Country | US
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Telephone | 269-806-5719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401225602
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License Number State | MI
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