Basic Information
| Provider Information | |||||||||
| NPI: | 1023624343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KERSJES | ||||||||
| FirstName: | DREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4428 MARGARET DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488137646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176525325 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Practice Location | |||||||||
| Address1: | 5123 W ST JOE HWY STE 103 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489174028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2020 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801103988 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.