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General NPI Number Information
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NPI Number | 1518393313
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Entity Type | Organization
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Legal Business Name | WEST MICHIGAN SUPPORT AND CONSULTATION PLLC
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Dates
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Enumeration Date | 09/25/2013
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 10854 NORTH CT
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City | ALLENDALE
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State | MI
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Zip | 49401-9773
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Country | US
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Telephone | 616-430-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 10854 NORTH CT
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City | ALLENDALE
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State | MI
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Zip | 49401-9773
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Country | US
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Telephone | 616-430-2826
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MICHAEL R GOLDSMITH
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Credential | MSW/LMSW
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Telephone | 616-430-2826
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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 | 6801090255
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License Number State | MI
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