Individual
CASSANDRA LYN FAIRBOTHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
650 S WAVERLY RD, HOLLAND, MI 49423-9121
(616) 591-9000
(616) 432-3059
Mailing address
4191 E VALLEY DR, HUDSONVILLE, MI 49426-7465
(616) 312-6822
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801120796
MI
Other
Enumeration date
08/07/2023
Last updated
11/07/2025
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