Healthcare Provider Details

I. General information

NPI: 1033531447
Provider Name (Legal Business Name): SABIRA PERVANIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 11/30/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2774 BIRCHCREST DR SE
GRAND RAPIDS MI
49506-5477
US

IV. Provider business mailing address

4591 BYRON CENTER AVE SW
WYOMING MI
49519-4805
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-3422
  • Fax:
Mailing address:
  • Phone: 616-430-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: