Provider Demographics
NPI:1679304430
Name:FITES, ADDISON FAITH
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:FAITH
Last Name:FITES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVVYN
Other - Middle Name:FAITH
Other - Last Name:FITES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:622 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2329
Mailing Address - Country:US
Mailing Address - Phone:217-548-0081
Mailing Address - Fax:517-548-0498
Practice Address - Street 1:622 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2329
Practice Address - Country:US
Practice Address - Phone:217-548-0081
Practice Address - Fax:517-548-0498
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator