Healthcare Provider Details

I. General information

NPI: 1134675168
Provider Name (Legal Business Name): CEDAR HILL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COLLEGE AVE SE STE 103
GRAND RAPIDS MI
49503-5921
US

IV. Provider business mailing address

103 COLLEGE AVE SE STE 103
GRAND RAPIDS MI
49503-5921
US

V. Phone/Fax

Practice location:
  • Phone: 616-222-0424
  • Fax:
Mailing address:
  • Phone: 616-222-0424
  • 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: MICHELLE ZOMER
Title or Position: OWNER
Credential: LMSW
Phone: 616-460-5608