Healthcare Provider Details

I. General information

NPI: 1972255578
Provider Name (Legal Business Name): BLUEBERRY HILL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 QUARRY AVE NW APT 1
GRAND RAPIDS MI
49504-3133
US

IV. Provider business mailing address

1337 QUARRY AVE NW APT 1
GRAND RAPIDS MI
49504-3133
US

V. Phone/Fax

Practice location:
  • Phone: 616-439-1872
  • Fax:
Mailing address:
  • Phone: 616-439-1872
  • 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. FLAVIO DA SILVA
Title or Position: OWNER
Credential: LMSW
Phone: 616-439-1872