Healthcare Provider Details

I. General information

NPI: 1013523976
Provider Name (Legal Business Name): DIVINE MIND COUNSELING AND CONSULTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7718
US

IV. Provider business mailing address

2040 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7718
US

V. Phone/Fax

Practice location:
  • Phone: 616-466-0358
  • Fax:
Mailing address:
  • Phone: 616-466-0358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN ELIZABETH CUPKA
Title or Position: COUNSELOR
Credential: LPC
Phone: 616-466-2924