Healthcare Provider Details

I. General information

NPI: 1144989419
Provider Name (Legal Business Name): MONICA MICHAEL MA LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6140 28TH ST SE STE 110
GRAND RAPIDS MI
49546-6938
US

IV. Provider business mailing address

PO BOX 930
ADA MI
49301-0930
US

V. Phone/Fax

Practice location:
  • Phone: 616-970-1599
  • Fax:
Mailing address:
  • Phone: 616-970-1599
  • 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: MONICA MARIA MICHAEL
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 616-970-1599