Provider Demographics
NPI:1982730040
Name:HAMES, DENISE MARIE (MSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:HAMES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:HAMES
Other - Last Name:HORAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:967 SPAULDING AVE SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-3700
Mailing Address - Country:US
Mailing Address - Phone:616-949-5330
Mailing Address - Fax:616-949-5336
Practice Address - Street 1:967 SPAULDING AVE SE
Practice Address - Street 2:SUITE E
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-3700
Practice Address - Country:US
Practice Address - Phone:616-949-5330
Practice Address - Fax:616-949-5336
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010574951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI089-5907-0OtherBLUE CROSS BLUE SHIELD
MI089-2974Medicare ID - Type Unspecified