Individual
JULIE MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLBSW
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-6571
Mailing address
7204 E GRAND RIVER AVE LOT 319, PORTLAND, MI 48875-8825
(517) 647-3149
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802091013
MI
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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