Healthcare Provider Details

I. General information

NPI: 1104500362
Provider Name (Legal Business Name): WITH PURPOSE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3167 KALAMAZOO AVE SE STE 116
GRAND RAPIDS MI
49508-1475
US

IV. Provider business mailing address

3167 KALAMAZOO AVE SE STE 116
GRAND RAPIDS MI
49508-1475
US

V. Phone/Fax

Practice location:
  • Phone: 616-340-1892
  • Fax:
Mailing address:
  • Phone: 616-340-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: BROOKE TOY DAVIS
Title or Position: OWNER
Credential: LMSW
Phone: 616-340-1892