Healthcare Provider Details

I. General information

NPI: 1609739556
Provider Name (Legal Business Name): HANNAH CHRISTINE MIRACLE LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

IV. Provider business mailing address

726 ANDREW AVE
JACKSON MI
49202-2070
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax:
Mailing address:
  • Phone: 517-936-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024695
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: