Provider Demographics
NPI:1477292480
Name:WEST MICHIGAN EATING DISORDER SPECIALISTS
Entity Type:Organization
Organization Name:WEST MICHIGAN EATING DISORDER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGGITT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-320-5111
Mailing Address - Street 1:2905 WILSON AVE SW STE 252
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-1206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2905 WILSON AVE SW STE 252
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-1206
Practice Address - Country:US
Practice Address - Phone:616-320-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty