Healthcare Provider Details

I. General information

NPI: 1902393440
Provider Name (Legal Business Name): CAPTIVE BELIEFS COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PLAINFIELD AVE NE STE 100
GRAND RAPIDS MI
49525-2087
US

IV. Provider business mailing address

5005 PLAINFIELD AVE NE STE 100
GRAND RAPIDS MI
49525-2087
US

V. Phone/Fax

Practice location:
  • Phone: 231-753-8823
  • Fax: 855-693-4641
Mailing address:
  • Phone: 231-753-8823
  • Fax: 855-693-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093508
License Number StateMI

VIII. Authorized Official

Name: BREANNE ROBERTS
Title or Position: MEMBER/CLINICAL THERAPIST
Credential: LMSW
Phone: 906-250-8855