Healthcare Provider Details

I. General information

NPI: 1801902481
Provider Name (Legal Business Name): HOLISTIC COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 WOODMEADOW DR SE A
GRAND RAPIDS MI
49546-8051
US

IV. Provider business mailing address

PO BOX 1767
GRAND RAPIDS MI
49501-1767
US

V. Phone/Fax

Practice location:
  • Phone: 616-862-3296
  • Fax:
Mailing address:
  • Phone: 616-235-2090
  • Fax: 616-235-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801082338
License Number StateMI

VIII. Authorized Official

Name: DEBORAH L JANDLE
Title or Position: OWNER
Credential: LMSW
Phone: 616-235-2090