Basic Information
| Provider Information | |||||||||
| NPI: | 1609140102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLOWERS | ||||||||
| FirstName: | SHAWNTINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 765 E. WEDGEWOOD BLVD. | ||||||||
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| City: | NORTH MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318559033 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 CHERRY ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169658200 | ||||||||
| FaxNumber: | 6169405360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2012 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801093714 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.