Healthcare Provider Details

I. General information

NPI: 1629597166
Provider Name (Legal Business Name): GRAND RAPIDS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 EASTERN AVE SE
GRAND RAPIDS MI
49507-3632
US

IV. Provider business mailing address

2400 EASTERN AVE SE
GRAND RAPIDS MI
49507-3632
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-3433
  • Fax:
Mailing address:
  • Phone: 616-988-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6401009578
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009578
License Number StateMI

VIII. Authorized Official

Name: MR. SEAN ALEXANDER ROBINSON
Title or Position: OWNER / EXECUTIVE DIRECTOR
Credential: LPC
Phone: 616-988-3433