Healthcare Provider Details

I. General information

NPI: 1265882583
Provider Name (Legal Business Name): ANNA JEAN SINCOCK M.A., LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA JEAN EDWARDS

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GALBRAITH AVE SE STE 304
GRAND RAPIDS MI
49546-6479
US

IV. Provider business mailing address

1813 BLANDFORD AVE SW
WYOMING MI
49519-1233
US

V. Phone/Fax

Practice location:
  • Phone: 616-541-5970
  • Fax:
Mailing address:
  • Phone: 616-928-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number640101548
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: