Healthcare Provider Details

I. General information

NPI: 1366710790
Provider Name (Legal Business Name): YOLANDA MARIE BUTCHER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LEONARD STREET NE LIFE GUIDANCE SERVICES
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

100 CHERRY STREET SE CHERRY STREET SERVICES, INC.
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-1991
  • Fax:
Mailing address:
  • Phone: 616-456-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801076472
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: