Provider Demographics
NPI:1447636097
Name:LITTS, AUDREY (LMSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:LITTS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:GERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:634 64TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-9379
Mailing Address - Country:US
Mailing Address - Phone:269-823-4873
Mailing Address - Fax:
Practice Address - Street 1:4079 PARK EAST CT SE
Practice Address - Street 2:SUITE C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8815
Practice Address - Country:US
Practice Address - Phone:616-425-2176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010949841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical