Provider Demographics
NPI:1841757499
Name:DATEMA, JOHNE L (LMSW)
Entity Type:Individual
Prefix:
First Name:JOHNE
Middle Name:L
Last Name:DATEMA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21020 LAKE MONTCALM RD
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-7900
Mailing Address - Country:US
Mailing Address - Phone:231-360-5996
Mailing Address - Fax:
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011033121041C0700X
MI68011102431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical