Provider Demographics
NPI:1417252123
Name:SVOBODA, MICHAELA (LMSW, CAADC, CCS)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:SVOBODA
Suffix:
Gender:F
Credentials:LMSW, CAADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4286
Mailing Address - Country:US
Mailing Address - Phone:616-396-5284
Mailing Address - Fax:616-396-8387
Practice Address - Street 1:377 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3664
Practice Address - Country:US
Practice Address - Phone:616-355-7095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical