Healthcare Provider Details

I. General information

NPI: 1629356175
Provider Name (Legal Business Name): RIA ANASTASIA NIEBOER LMSW, CAADC, ADS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. RIE NIEBOER

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 WASHINGTON AVE SUITE 210
HOLLAND MI
49423-7725
US

IV. Provider business mailing address

926 WASHINGTON AVE SUITE 210
HOLLAND MI
49423-7725
US

V. Phone/Fax

Practice location:
  • Phone: 616-820-3780
  • Fax: 616-820-3785
Mailing address:
  • Phone: 616-820-3780
  • Fax: 616-820-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: