Healthcare Provider Details

I. General information

NPI: 1811764426
Provider Name (Legal Business Name): IMMACULATE HEART COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 REMEMBRANCE RD NW STE 3
GRAND RAPIDS MI
49534-7745
US

IV. Provider business mailing address

210 LEYDEN AVE SW
GRAND RAPIDS MI
49504-6129
US

V. Phone/Fax

Practice location:
  • Phone: 616-379-9191
  • Fax:
Mailing address:
  • Phone: 301-655-8933
  • 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: MR. WILLIAM EDWARD ROBINSON
Title or Position: OWNER/COUNSELOR
Credential: M.DIV, MA, LPC
Phone: 301-655-8933