Provider Demographics
NPI:1376802215
Name:KOENIGSHOF, ANDREA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:KOENIGSHOF
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8765 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48815-9717
Mailing Address - Country:US
Mailing Address - Phone:616-822-2793
Mailing Address - Fax:
Practice Address - Street 1:8765 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48815-9717
Practice Address - Country:US
Practice Address - Phone:616-822-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010922871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical