Healthcare Provider Details

I. General information

NPI: 1013441161
Provider Name (Legal Business Name): CASSANDRA FAYE PATTERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA FAYE GILKEY

II. Dates (important events)

Enumeration Date: 04/16/2017
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE BUILDING 3, STE 303
GRAND RAPIDS MI
49525-9350
US

IV. Provider business mailing address

PO BOX 140241
GRAND RAPIDS MI
49514-0241
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-2762
  • Fax:
Mailing address:
  • Phone: 616-735-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015962
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017265
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401017265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: