Healthcare Provider Details

I. General information

NPI: 1124896402
Provider Name (Legal Business Name): FRESH SANDS COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2023
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 CASCADE RD SE STE 200
GRAND RAPIDS MI
49546-3665
US

IV. Provider business mailing address

9578 SNOW VALLEY DR SE
ALTO MI
49302-8989
US

V. Phone/Fax

Practice location:
  • Phone: 616-287-5331
  • Fax: 616-469-1124
Mailing address:
  • Phone: 616-287-5331
  • Fax: 616-469-1124

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: MR. BRADLEY BRIDGES
Title or Position: CO-OWNER
Credential: MSW
Phone: 616-287-5331