Individual
AMBER PETISCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE BLDG C, GRAND RAPIDS, MI 49505-5904
(616) 459-7215
Mailing address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 459-7215
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6851109818
MI
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
04/26/2022
Last updated
04/26/2022
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