Healthcare Provider Details

I. General information

NPI: 1538477328
Provider Name (Legal Business Name): LISA S. DEITERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 CENTURY LN STE 2
HOLLAND MI
49423-4318
US

IV. Provider business mailing address

503 CENTURY LN STE 2
HOLLAND MI
49423-4318
US

V. Phone/Fax

Practice location:
  • Phone: 616-730-1556
  • Fax:
Mailing address:
  • Phone: 616-730-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401009532
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009532
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: