Individual
PATIENT KATABANA BARAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LLMSW
Contact information
Practice address
255 COLRAIN ST SW, WYOMING, MI 49548-1013
(616) 988-1479
(616) 245-0450
Mailing address
79 ANTOINE ST SW, GRAND RAPIDS, MI 49507-1001
(616) 988-1479
(616) 245-0450
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6801093577
MI
Other
Enumeration date
05/31/2013
Last updated
05/31/2013
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