Healthcare Provider Details

I. General information

NPI: 1780274076
Provider Name (Legal Business Name): HEART WALK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4829 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49525-9349
US

IV. Provider business mailing address

4829 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49525-9349
US

V. Phone/Fax

Practice location:
  • Phone: 616-477-5694
  • Fax:
Mailing address:
  • Phone: 616-477-5694
  • 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: RHEA-ALANA RICHARDSON
Title or Position: OWNER
Credential: LPC
Phone: 616-477-5694