Provider Demographics
NPI:1902120884
Name:STIENSTRA, AMANDA MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:MARIE
Last Name:STIENSTRA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 PORT SHELDON ST STE E
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-7898
Mailing Address - Country:US
Mailing Address - Phone:616-379-9845
Mailing Address - Fax:
Practice Address - Street 1:2874 PORT SHELDON ST STE E
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-7898
Practice Address - Country:US
Practice Address - Phone:616-379-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-20
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091766104100000X
1041C0700X
68010917661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker