Provider Demographics
NPI:1952603276
Name:VERHAGE, KARLA SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:SUE
Last Name:VERHAGE
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 1:740 36TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-2344
Mailing Address - Country:US
Mailing Address - Phone:616-456-6571
Mailing Address - Fax:616-475-8304
Practice Address - Street 1:740 36TH ST SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-2344
Practice Address - Country:US
Practice Address - Phone:616-456-6571
Practice Address - Fax:616-475-8304
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical