Healthcare Provider Details

I. General information

NPI: 1336727676
Provider Name (Legal Business Name): PEACE LOVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3282 CLEAR VISTA CT NE STE B
GRAND RAPIDS MI
49525-9766
US

IV. Provider business mailing address

5029 CANAL AVE SW
WYOMING MI
49418-9722
US

V. Phone/Fax

Practice location:
  • Phone: 616-286-1905
  • Fax:
Mailing address:
  • Phone: 810-252-0929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELLE BUNO
Title or Position: COUNSELOR
Credential: LMSW
Phone: 810-252-0929