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General NPI Number Information
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NPI Number | 1790416881
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Entity Type | Organization
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Legal Business Name | FAMILY WHOLENESS PLLC
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Dates
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Enumeration Date | 06/21/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 800 MONROE AVE NW STE 202
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 214-212-2703
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Fax |
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Provider Business Mailing Address
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Address Line | 1680 44TH ST SE UNIT 88333
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City | GRAND RAPIDS
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State | MI
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Zip | 49518-5050
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Country | US
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Telephone | 214-212-2703
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOPHIA DYKSTRA
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Credential | LPN, NCC, CAADC
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Telephone | 616-920-1892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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