Provider Demographics
NPI:1528310497
Name:CAMMENGA, SANDRA J (MDIV, LMSW)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:J
Last Name:CAMMENGA
Suffix:
Gender:F
Credentials:MDIV, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 RIVERBEND CT
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-1487
Mailing Address - Country:US
Mailing Address - Phone:616-772-5555
Mailing Address - Fax:
Practice Address - Street 1:221 RIVERBEND CT
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1487
Practice Address - Country:US
Practice Address - Phone:616-772-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)