Provider Demographics
NPI:1053662999
Name:HUNDLEY, KATHERINE MANDI (BSW)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MANDI
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:MANDI
Other - Last Name:HUNDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW
Mailing Address - Street 1:1403 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1831
Mailing Address - Country:US
Mailing Address - Phone:313-565-2200
Mailing Address - Fax:
Practice Address - Street 1:32715 DORSEY ST
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4755
Practice Address - Country:US
Practice Address - Phone:734-641-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085991104100000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6802085991OtherSTATE OF MICHIGAN