Provider Demographics
NPI:1851696447
Name:WEITZEL, WILLIAM JAMES (LMSW ACSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:WEITZEL
Suffix:
Gender:M
Credentials:LMSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3396 HIDDEN HILLS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-9125
Mailing Address - Country:US
Mailing Address - Phone:616-446-1873
Mailing Address - Fax:
Practice Address - Street 1:4467 CASCADE RD SE
Practice Address - Street 2:SUITE 4467
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3776
Practice Address - Country:US
Practice Address - Phone:616-446-1873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010114101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical