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General NPI Number Information
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NPI Number | 1265239867
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Entity Type | Organization
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Legal Business Name | EJDE CONSULTING
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Dates
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Enumeration Date | 03/01/2025
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 241 FINNEY AVE SW STE 4
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4311
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Country | US
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Telephone | 616-648-2686
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Fax |
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Provider Business Mailing Address
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Address Line | 4279 SAWKAW DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6513
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Country | US
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Telephone | 616-648-2686
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERIC DESANTIS
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Credential | LPC
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Telephone | 616-648-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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