Healthcare Provider Details

I. General information

NPI: 1720659949
Provider Name (Legal Business Name): JOHNNA ALOFS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 JAMES ST
HOLLAND MI
49424-8613
US

IV. Provider business mailing address

3089 112TH AVE
HOLLAND MI
49424-8611
US

V. Phone/Fax

Practice location:
  • Phone: 616-494-5432
  • Fax:
Mailing address:
  • Phone: 616-340-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6451019338
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: