Healthcare Provider Details

I. General information

NPI: 1699725127
Provider Name (Legal Business Name): CHRISTIAN COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 LEONARD NE
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

1870 LEONARD ST NE
GRAND RAPIDS MI
49505-5650
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-1122
  • Fax: 616-956-8033
Mailing address:
  • Phone: 616-956-1122
  • Fax: 616-956-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM SWISHER
Title or Position: BILLING
Credential:
Phone: 616-942-8060