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General NPI Number Information
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NPI Number | 1336727676
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Entity Type | Organization
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Legal Business Name | PEACE LOVE COUNSELING, LLC
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 3282 CLEAR VISTA CT NE STE B
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9766
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Country | US
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Telephone | 616-286-1905
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 CANAL AVE SW
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City | WYOMING
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State | MI
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Zip | 49418-9722
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Country | US
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Telephone | 810-252-0929
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. DANIELLE BUNO
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Credential | LMSW
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Telephone | 810-252-0929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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