Healthcare Provider Details

I. General information

NPI: 1730840760
Provider Name (Legal Business Name): COMMON GROUND COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2022
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 LOVETT AVE SE STE C
GRAND RAPIDS MI
49506-3040
US

IV. Provider business mailing address

1354 BALDWIN ST STE 106
JENISON MI
49428-8937
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-2020
  • Fax:
Mailing address:
  • Phone: 616-315-2020
  • 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: ELIZABETH JABOUR
Title or Position: THERAPIST
Credential: LMSW
Phone: 616-315-2020