Healthcare Provider Details

I. General information

NPI: 1811370570
Provider Name (Legal Business Name): LISA NICOLE VROMAN STOKES PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA NICOLE VROMAN

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-8614
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-6495
  • Fax: 616-447-5828
Mailing address:
  • Phone: 616-486-6790
  • Fax: 616-486-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016551
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: