Healthcare Provider Details

I. General information

NPI: 1760872790
Provider Name (Legal Business Name): DEBRA DOMINIAK-RINCK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PARCHMENT DR SE PSYCHOLOGY ASSOCIATES OF GRAND RAPIDS, PC
GRAND RAPIDS MI
49546
US

IV. Provider business mailing address

1000 PARCHMENT DR. SE PSYCHOLOGY ASSOCIATES OF GRAND RAPIDS, PC
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 616-957-9112
  • Fax: 616-957-2409
Mailing address:
  • Phone: 616-957-9112
  • Fax: 616-957-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: