Provider Demographics
NPI:1558878223
Name:BRITO, CAROLINA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:BRITO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 MELVIN ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-1664
Mailing Address - Country:US
Mailing Address - Phone:616-438-5728
Mailing Address - Fax:
Practice Address - Street 1:5270 NORTHLAND DR NE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1073
Practice Address - Country:US
Practice Address - Phone:616-915-4769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801109515104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker