Individual
DIANA JACKSON-WHITFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA/LBSW
Contact information
Practice address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
(616) 336-2475
Mailing address
790 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 336-3909
(616) 336-2475
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
6802065185
MI
104100000X
Social Worker
Primary
6802065185
MI
Other
Enumeration date
03/09/2015
Last updated
03/09/2015
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