Provider Demographics
NPI:1043990708
Name:EGELAND, DORACE A (LMSW)
Entity type:Individual
Prefix:
First Name:DORACE
Middle Name:A
Last Name:EGELAND
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DORACE
Other - Middle Name:A
Other - Last Name:VAN MEURS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1422 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2717
Mailing Address - Country:US
Mailing Address - Phone:616-901-6136
Mailing Address - Fax:
Practice Address - Street 1:1422 WEALTHY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2717
Practice Address - Country:US
Practice Address - Phone:616-901-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010724271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical