Provider Demographics
NPI:1003308503
Name:KATIE DOLE LLC
Entity Type:Organization
Organization Name:KATIE DOLE LLC
Other - Org Name:MITTEN MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SAPITA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-881-1058
Mailing Address - Street 1:2580 SORORITY LN
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-9427
Mailing Address - Country:US
Mailing Address - Phone:616-881-1058
Mailing Address - Fax:
Practice Address - Street 1:2190 AURELIUS RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-5540
Practice Address - Country:US
Practice Address - Phone:616-881-1058
Practice Address - Fax:616-818-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801092197251S00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health