Healthcare Provider Details

I. General information

NPI: 1912601618
Provider Name (Legal Business Name): PRUDENTIA COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E BELTLINE AVE SE STE 102
GRAND RAPIDS MI
49546-7673
US

IV. Provider business mailing address

437 MULFORD DR SE
GRAND RAPIDS MI
49507-3568
US

V. Phone/Fax

Practice location:
  • Phone: 616-446-6718
  • Fax:
Mailing address:
  • Phone: 616-446-6718
  • Fax:

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: MR. NOAH J MENEREY
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW-CAADC
Phone: 616-446-6718