Healthcare Provider Details

I. General information

NPI: 1053275826
Provider Name (Legal Business Name): DOUGLAS COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 COIT AVE NE APT 4
GRAND RAPIDS MI
49505-6249
US

IV. Provider business mailing address

2049 COIT AVE NE APT 4
GRAND RAPIDS MI
49505-6249
US

V. Phone/Fax

Practice location:
  • Phone: 269-903-7691
  • Fax:
Mailing address:
  • Phone:
  • 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: MARK DOUGLAS
Title or Position: OWNER
Credential: LMSW
Phone: 269-903-7691