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Organization
GAYLE WITHAM
Active
Organization
GAYLE WITHAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GAYLE WITHAM LMSW, ACM (SOCIAL WORK)
(616) 477-3404
Entity
Organization
Contact information
Practice address
558 WINONA AVE NW, GRAND RAPIDS, MI 49504-4740
(616) 477-3404
Mailing address
558 WINONA AVE NW, GRAND RAPIDS, MI 49504-4740
(616) 477-3404
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801085993
MI
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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