Provider Demographics
NPI:1386399301
Name:SAVANNA VANDERBERG
Entity type:Organization
Organization Name:SAVANNA VANDERBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-607-4858
Mailing Address - Street 1:185 44TH ST SW STE E
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3363
Mailing Address - Country:US
Mailing Address - Phone:616-607-4858
Mailing Address - Fax:616-719-2677
Practice Address - Street 1:185 44TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3363
Practice Address - Country:US
Practice Address - Phone:616-607-4858
Practice Address - Fax:616-719-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty