Healthcare Provider Details

I. General information

NPI: 1386256675
Provider Name (Legal Business Name): NADINE ARLENE BATTLES LLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

V. Phone/Fax

Practice location:
  • Phone: 162-587-4676
  • Fax: 616-258-7432
Mailing address:
  • Phone: 616-455-5000
  • Fax: 616-258-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401016601
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: