Healthcare Provider Details

I. General information

NPI: 1699016188
Provider Name (Legal Business Name): COUNSELING ASSOCIATES OF WEST MICHIGAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4127 EMBASSY DR SE
GRAND RAPIDS MI
49546-2418
US

IV. Provider business mailing address

4127 EMBASSY DR SE
GRAND RAPIDS MI
49546-2418
US

V. Phone/Fax

Practice location:
  • Phone: 616-264-3200
  • Fax: 616-264-3201
Mailing address:
  • Phone: 616-264-3200
  • Fax: 616-264-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801058815
License Number StateMI

VIII. Authorized Official

Name: MRS. MARY B LIER
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LMSW, ACSW
Phone: 616-264-3200