Provider Demographics
NPI:1366253866
Name:STEPHEN DEWIT THERAPY
Entity type:Organization
Organization Name:STEPHEN DEWIT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALBERT BERNARD
Authorized Official - Last Name:DEWIT
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:616-745-9391
Mailing Address - Street 1:1436 DERBYSHIRE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-2544
Mailing Address - Country:US
Mailing Address - Phone:616-745-9391
Mailing Address - Fax:
Practice Address - Street 1:1428 44TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4312
Practice Address - Country:US
Practice Address - Phone:616-745-9391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty