Healthcare Provider Details

I. General information

NPI: 1578495214
Provider Name (Legal Business Name): ANGELA BELSITO-FANTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 305
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

7549 MEDINAH DR
HUDSONVILLE MI
49426-7565
US

V. Phone/Fax

Practice location:
  • Phone: 616-334-3400
  • Fax:
Mailing address:
  • Phone: 616-334-3400
  • Fax: 616-334-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: