Provider Demographics
NPI:1114578291
Name:STOREY, SAVANNAH (LLMSW)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:STOREY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BARFIELD DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-2599
Mailing Address - Country:US
Mailing Address - Phone:269-512-4395
Mailing Address - Fax:269-948-9319
Practice Address - Street 1:3283 122ND AVE
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-9590
Practice Address - Country:US
Practice Address - Phone:269-512-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020906281041C0700X
MI6851110551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical