Individual
EBONY R BETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 855-8963
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6852089338
MI
Other
Enumeration date
09/30/2021
Last updated
09/30/2021
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