Provider Demographics
NPI:1780394460
Name:KARA PETTINGER, L.L.C.
Entity type:Organization
Organization Name:KARA PETTINGER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PETTINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:517-983-3384
Mailing Address - Street 1:5741 DORADO CT NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8335
Mailing Address - Country:US
Mailing Address - Phone:517-983-3384
Mailing Address - Fax:
Practice Address - Street 1:630 KENMOOR AVE SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8626
Practice Address - Country:US
Practice Address - Phone:517-983-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689086654OtherNPI