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General NPI Number Information
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NPI Number | 1912601618
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Entity Type | Organization
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Legal Business Name | PRUDENTIA COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 2025 E BELTLINE AVE SE STE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-7673
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Country | US
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Telephone | 616-446-6718
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Fax |
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Provider Business Mailing Address
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Address Line | 437 MULFORD DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-3568
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Country | US
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Telephone | 616-446-6718
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. NOAH J MENEREY
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Credential | LMSW-CAADC
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Telephone | 616-446-6718
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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 |
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License Number State |
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