Provider Demographics
NPI:1457193823
Name:ABERNATHY, DAVID SCOTT (LLMSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:SCOTT
Last Name:ABERNATHY
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1849
Mailing Address - Country:US
Mailing Address - Phone:616-399-0200
Mailing Address - Fax:
Practice Address - Street 1:285 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1849
Practice Address - Country:US
Practice Address - Phone:616-399-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511180141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical