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General NPI Number Information
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NPI Number | 1477168490
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Entity Type | Individual
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Provider Name | VANESSA BENAWAY
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Gender | Female
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 57239 N MAIN ST STE 1
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City | THREE RIVERS
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State | MI
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Zip | 49093-9419
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Country | US
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Telephone | 269-273-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 2509 OMEGA DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6710
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Country | US
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Telephone | 906-235-7248
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4151000706
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License Number State | MI
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