Provider Demographics
NPI:1053908822
Name:VANHAITSMA, KIMBERLEY JOANNE (LMSW)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JOANNE
Last Name:VANHAITSMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 VERMONT AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1676
Mailing Address - Country:US
Mailing Address - Phone:616-446-7240
Mailing Address - Fax:
Practice Address - Street 1:3102 VERMONT AVE SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1676
Practice Address - Country:US
Practice Address - Phone:616-446-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010924571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical