Healthcare Provider Details

I. General information

NPI: 1346930880
Provider Name (Legal Business Name): WISE PATH COUNSELING SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9494
US

IV. Provider business mailing address

137 LINCOLN CT
ROCKFORD MI
49341-1317
US

V. Phone/Fax

Practice location:
  • Phone: 616-307-1046
  • Fax:
Mailing address:
  • Phone: 616-307-1046
  • 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: RACHEL LETTINGA
Title or Position: OWNER
Credential: LMSW
Phone: 616-307-1046