Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 6451019569 | MI |
NPI | 1003589565 |
---|---|
Provider Name | Amanda Joy Rewa |
First Address | Ada, MI 49301-9667 |
Second Address | Grand Rapids, MI 49503-1891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2021 |
Last Update Date | 29/07/2021 |