Individual
ANNITA LIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
744 BURTON ST SE, GRAND RAPIDS, MI 49507-3204
(616) 451-1965
(616) 451-2012
Mailing address
5423 CLAUDIA AVE SE, KENTWOOD, MI 49548-5844
(616) 531-5315
(616) 451-1965
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801061325
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7000013901
—
MI
01
—
I01
NETWORK180
MI
Enumeration date
05/23/2007
Last updated
07/09/2007
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