Provider Demographics
NPI:1083059802
Name:HARRISON, KAHANA (LMSW/CAADC)
Entity Type:Individual
Prefix:
First Name:KAHANA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMSW/CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 DEVONWOOD HLS NE APT C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6805
Mailing Address - Country:US
Mailing Address - Phone:616-581-3826
Mailing Address - Fax:
Practice Address - Street 1:255 COLRAIN ST SW STE 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-1013
Practice Address - Country:US
Practice Address - Phone:616-988-1479
Practice Address - Fax:616-988-1493
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010890951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical