Healthcare Provider Details

I. General information

NPI: 1801645015
Provider Name (Legal Business Name): SARAH KOCSIS M.DIV, M.A., LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2024
Last Update Date: 05/18/2024
Certification Date: 05/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 CASCADE RD SE STE 100
GRAND RAPIDS MI
49546-2135
US

IV. Provider business mailing address

4081 CASCADE RD SE STE 100
GRAND RAPIDS MI
49546-2135
US

V. Phone/Fax

Practice location:
  • Phone: 616-319-1978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: