Healthcare Provider Details

I. General information

NPI: 1417308404
Provider Name (Legal Business Name): CHRISTINE OLSON MA, NCC, LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

1835 AMHURST ST NE
GRAND RAPIDS MI
49503-3870
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax:
Mailing address:
  • Phone: 510-520-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401015481
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: