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General NPI Number Information
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NPI Number | 1942739156
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Entity Type | Organization
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Legal Business Name | RECONCILIATION OF LIFE
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Dates
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Enumeration Date | 06/09/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1028 CASS AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-1120
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Country | US
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Telephone | 616-241-3396
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Fax |
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Provider Business Mailing Address
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Address Line | 1028 CASS AVE.SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507
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Country | US
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Telephone | 616-241-3396
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. WANDA ANN ROGERS
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Credential | MA, EDD
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Telephone | 616-241-3396
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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 | 6401011542
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License Number State | MI
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