Healthcare Provider Details

I. General information

NPI: 1265177422
Provider Name (Legal Business Name): A CONSCIOUS JOURNEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MONROE AVE NW STE 217
GRAND RAPIDS MI
49503-1451
US

IV. Provider business mailing address

4593 CANTERWOOD DR NE
ADA MI
49301-8712
US

V. Phone/Fax

Practice location:
  • Phone: 616-984-0899
  • Fax:
Mailing address:
  • Phone: 248-935-5135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: AMANDA COLLEY JACOBSON
Title or Position: COUNSELOR
Credential: LPC
Phone: 616-984-0899