Provider Demographics
NPI:1497547160
Name:FORTUNA, MICHELLE DAWN (LMSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:FORTUNA
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:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - Street 2:300 68TH STREET SE
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-644-0787
Mailing Address - Fax:
Practice Address - Street 1:6505 CHERRY MEADOW DR SE
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9484
Practice Address - Country:US
Practice Address - Phone:616-644-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010888571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical