Organization
GERONTOLOGY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS A HARTWIG PHD (PRESIDENT CEO)
(616) 456-6135
Entity
Organization
Contact information
Practice address
516 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
(616) 771-9771
Mailing address
500 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
(616) 771-9771
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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