Healthcare Provider Details

I. General information

NPI: 1588393870
Provider Name (Legal Business Name): ANDREW MICHAEL WOZNICK MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 MEDICAL PARK DR SE STE 200
GRAND RAPIDS MI
49546-3681
US

IV. Provider business mailing address

1001 MEDICAL PARK DR SE STE 200
GRAND RAPIDS MI
49546-3681
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-5326
  • Fax:
Mailing address:
  • Phone: 616-259-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401225346
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: