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General NPI Number Information
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NPI Number | 1538968151
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Entity Type | Individual
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Provider Name | MICAH B ENOCH LLMSW
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Gender | Female
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Dates
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Enumeration Date | 03/08/2025
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 2335 BURTON ST SE STE 210
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-4669
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Country | US
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Telephone | 616-236-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 945 BEECHWOOD ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3709
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Country | US
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Telephone | 616-446-1364
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851114723
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License Number State | MI
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