Healthcare Provider Details

I. General information

NPI: 1235619214
Provider Name (Legal Business Name): DAMIKA MARIE HOUSTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 33RD ST SE
GRAND RAPIDS MI
49508-2435
US

IV. Provider business mailing address

5180 KALAMAZOO AVE SE STE 2
KENTWOOD MI
49508-4817
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-8146
  • Fax:
Mailing address:
  • Phone: 616-287-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015434
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: