Provider Demographics
NPI:1053957753
Name:AYEW-EW, MICHAELA DAWN (LPC, PMH-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:DAWN
Last Name:AYEW-EW
Suffix:
Gender:F
Credentials:LPC, PMH-C
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:DAWN
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 84TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9344
Mailing Address - Country:US
Mailing Address - Phone:616-222-0631
Mailing Address - Fax:
Practice Address - Street 1:1410 84TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9344
Practice Address - Country:US
Practice Address - Phone:616-222-0631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20191212945579Medicaid