Healthcare Provider Details

I. General information

NPI: 1427254275
Provider Name (Legal Business Name): SANDRA KAY VANDENBRINK L.M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 3 MILE RD NW
GRAND RAPIDS MI
49544-1614
US

IV. Provider business mailing address

3933 KERRI CT
HOLLAND MI
49424-9492
US

V. Phone/Fax

Practice location:
  • Phone: 616-784-5095
  • Fax:
Mailing address:
  • Phone: 616-738-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801017554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: