Healthcare Provider Details

I. General information

NPI: 1669306155
Provider Name (Legal Business Name): MS. ROCHELLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

IV. Provider business mailing address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-2021
  • Fax:
Mailing address:
  • Phone: 616-451-2021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451024687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: