Healthcare Provider Details

I. General information

NPI: 1780457192
Provider Name (Legal Business Name): LOTUS CENTER FOR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 LAKE DR SE STE 4
GRAND RAPIDS MI
49506-1673
US

IV. Provider business mailing address

2254 SHAWNEE DR SE
GRAND RAPIDS MI
49506-5335
US

V. Phone/Fax

Practice location:
  • Phone: 616-377-4555
  • Fax:
Mailing address:
  • Phone: 616-334-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ABIGAIL SMITH
Title or Position: OWNER
Credential: LPC
Phone: 616-334-6584