Healthcare Provider Details

I. General information

NPI: 1689814469
Provider Name (Legal Business Name): CENTENNIAL PARK COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 KRAFT AVE SE SUITE 186
GRAND RAPIDS MI
49512
US

IV. Provider business mailing address

2828 KRAFT AVE SE STE 186
GRAND RAPIDS MI
49512-2076
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-9550
  • Fax: 616-949-9551
Mailing address:
  • Phone: 616-949-9550
  • Fax: 616-949-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801063539
License Number StateMI

VIII. Authorized Official

Name: BRIAN WILLIAM BERCE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 616-949-9550