Healthcare Provider Details

I. General information

NPI: 1104519859
Provider Name (Legal Business Name): KAYLA PACIC COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 PLAINFIELD AVE NE STE D
GRAND RAPIDS MI
49525-1010
US

IV. Provider business mailing address

4920 PLAINFIELD AVE NE STE D
GRAND RAPIDS MI
49525-1010
US

V. Phone/Fax

Practice location:
  • Phone: 313-403-8464
  • Fax:
Mailing address:
  • Phone: 313-403-8464
  • 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: KAYLA PACIC
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential:
Phone: 313-403-8464