Provider Demographics
NPI:1740658673
Name:JUSTINE BRAFORD LLC
Entity type:Organization
Organization Name:JUSTINE BRAFORD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-264-3200
Mailing Address - Street 1:4127 EMBASSY DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2418
Mailing Address - Country:US
Mailing Address - Phone:616-264-3200
Mailing Address - Fax:616-264-3201
Practice Address - Street 1:4127 EMBASSY DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2418
Practice Address - Country:US
Practice Address - Phone:616-264-3200
Practice Address - Fax:616-264-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010927971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty