Provider Demographics
NPI:1003589565
Name:REWA, AMANDA JOY (MA, LLPC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JOY
Last Name:REWA
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 PRESERVATION DR NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9667
Mailing Address - Country:US
Mailing Address - Phone:231-577-8284
Mailing Address - Fax:
Practice Address - Street 1:221 TROWBRIDGE ST NE APT 208
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1891
Practice Address - Country:US
Practice Address - Phone:231-755-8284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451019569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional