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General NPI Number Information
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NPI Number | 1841851169
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Entity Type | Organization
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Legal Business Name | CHELSEA WIERSEMA LMSW, LLC
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 185 44TH ST SW STE E
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City | GRANDVILLE
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State | MI
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Zip | 49418-3363
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Country | US
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Telephone | 616-294-0754
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Fax |
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Provider Business Mailing Address
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Address Line | 4240 HAVANA AVE SW
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City | WYOMING
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State | MI
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Zip | 49509-4347
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Country | US
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Telephone | 616-617-6493
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Fax |
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Authorized Official
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Title or Position | CLINICAL THERAPIST/ LLC OWNER
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Name | CHELSEA ANNE WIERSEMA
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Credential | LMSW
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Telephone | 616-617-6493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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