Healthcare Provider Details

I. General information

NPI: 1891304713
Provider Name (Legal Business Name): COMPREHENSIVE COUNSELING CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 44TH ST SE STE C
GRAND RAPIDS MI
49508-5349
US

IV. Provider business mailing address

2021 44TH ST SE STE C
GRAND RAPIDS MI
49508-5349
US

V. Phone/Fax

Practice location:
  • Phone: 616-777-7399
  • Fax: 616-773-1383
Mailing address:
  • Phone: 616-777-7399
  • Fax: 616-773-1383

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: CHERIE RUCKER
Title or Position: PROVIDER
Credential:
Phone: 616-589-4715