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General NPI Number Information
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NPI Number | 1841387099
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Entity Type | Organization
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Legal Business Name | THIRD COAST COUNSELING CENTER
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 1514 WEALTHY ST SE STE 260
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2755
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Country | US
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Telephone | 616-451-3008
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Fax | 616-451-3070
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Provider Business Mailing Address
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Address Line | 1514 WEALTHY ST SE STE 260
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-2755
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Country | US
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Telephone | 616-451-3008
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Fax | 616-451-3070
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. JAMES C MITCHELL
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Credential | M.A., LMSW
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Telephone | 616-451-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801035829
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License Number State | MI
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