Healthcare Provider Details

I. General information

NPI: 1235666561
Provider Name (Legal Business Name): ANDREW R DONALDSON MA, LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546-2166
US

IV. Provider business mailing address

500 CASCADE WEST PKWY SE STE 240
GRAND RAPIDS MI
49546-2166
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-9000
  • Fax: 616-591-9060
Mailing address:
  • Phone: 616-591-9000
  • Fax: 616-591-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: