Provider Demographics
NPI:1295588440
Name:GEORGACAKES, AUSTIN MARIE
Entity type:Individual
Prefix:MRS
First Name:AUSTIN
Middle Name:MARIE
Last Name:GEORGACAKES
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 1:3565 BALSAM AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2838
Mailing Address - Country:US
Mailing Address - Phone:616-821-1900
Mailing Address - Fax:
Practice Address - Street 1:3565 BALSAM AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2838
Practice Address - Country:US
Practice Address - Phone:616-821-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker