Provider Demographics
NPI:1598983587
Name:GICHEMI, DEWANDA L (LMSW, IPT-A, CTMH)
Entity Type:Individual
Prefix:MRS
First Name:DEWANDA
Middle Name:L
Last Name:GICHEMI
Suffix:
Gender:F
Credentials:LMSW, IPT-A, CTMH
Other - Prefix:MRS
Other - First Name:DEWANDA
Other - Middle Name:L
Other - Last Name:GICHEMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW, IPT-A, CTMH
Mailing Address - Street 1:4654 MIDDLEBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3990
Mailing Address - Country:US
Mailing Address - Phone:616-466-1456
Mailing Address - Fax:
Practice Address - Street 1:1843 R W BERENDS DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4955
Practice Address - Country:US
Practice Address - Phone:616-466-1456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041S0200X
MI68010891191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool