Healthcare Provider Details

I. General information

NPI: 1467946723
Provider Name (Legal Business Name): THE SANA INITIATIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 ADA DR SE
ADA MI
49301-9160
US

IV. Provider business mailing address

13536 KELANNI DR
FREEPORT MI
49325-9628
US

V. Phone/Fax

Practice location:
  • Phone: 616-929-0248
  • Fax:
Mailing address:
  • Phone: 616-929-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401014056
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801097875
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100309
License Number StateMI

VIII. Authorized Official

Name: MS. KATHRYN ZUVERINK
Title or Position: CO-FOUNDER
Credential: M.ED., LPC
Phone: 616-929-0248