Healthcare Provider Details

I. General information

NPI: 1124633185
Provider Name (Legal Business Name): WILLIAM EDWARD ROBINSON M.DIV, MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 REMEMBRANCE RD NW STE 3
GRAND RAPIDS MI
49534-7745
US

IV. Provider business mailing address

210 LEYDEN AVE SW
GRAND RAPIDS MI
49504-6129
US

V. Phone/Fax

Practice location:
  • Phone: 616-379-9191
  • Fax:
Mailing address:
  • Phone: 616-379-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451018634
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: