Healthcare Provider Details

I. General information

NPI: 1003015876
Provider Name (Legal Business Name): DANA KAY ANDERSON MA, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 EASTERN AVE NE
GRAND RAPIDS MI
49503-1201
US

IV. Provider business mailing address

901 EASTERN AVE NE
GRAND RAPIDS MI
49503-1201
US

V. Phone/Fax

Practice location:
  • Phone: 616-254-7741
  • Fax: 616-254-7750
Mailing address:
  • Phone: 616-254-7741
  • Fax: 616-254-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009024
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: