Individual
MR. ANDREW EUGENE EASTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1108 ECKLUND ST NE, GRAND RAPIDS, MI 49505-4324
(616) 970-9536
Mailing address
1108 ECKLUND ST NE, GRAND RAPIDS, MI 49505-4324
(616) 970-9536
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801081217
MI
1041C0700X
Clinical Social Worker
6801081217
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6801081217
—
MI
Enumeration date
12/30/2021
Last updated
12/30/2021
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