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General NPI Number Information
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NPI Number | 1972041721
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Entity Type | Organization
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Legal Business Name | COMMUNITY RECOVERY COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 1975 JEFFERSON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-2511
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Country | US
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Telephone | 616-678-3622
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Fax | 616-678-3622
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Provider Business Mailing Address
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Address Line | 1975 JEFFERSON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-2511
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Country | US
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Telephone | 616-678-3622
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Fax | 616-678-3622
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MRS. KRISTINA M WESSELS
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Credential | LPC
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Telephone | 616-678-3622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6401012530
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License Number State | MI
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