Healthcare Provider Details

I. General information

NPI: 1790386696
Provider Name (Legal Business Name): COURTNEY ALBIN COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 ARDMORE ST SE STE 202B
GRAND RAPIDS MI
49506-4901
US

IV. Provider business mailing address

862 MERRIFIELD ST SE
GRAND RAPIDS MI
49507-3336
US

V. Phone/Fax

Practice location:
  • Phone: 616-209-9192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY ALBIN
Title or Position: OWNER/THERAPIST
Credential:
Phone: 616-322-9517