Provider Demographics
NPI:1558604850
Name:VANKEMPEN, CRAIG (LMSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:VANKEMPEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 E JEFFERSON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4180
Mailing Address - Country:US
Mailing Address - Phone:313-446-9805
Mailing Address - Fax:313-446-9839
Practice Address - Street 1:2751 E JEFFERSON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4180
Practice Address - Country:US
Practice Address - Phone:313-446-9805
Practice Address - Fax:313-446-9839
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010928801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical