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General NPI Number Information
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NPI Number | 1972102085
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Entity Type | Organization
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Legal Business Name | RLD LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 2922 FULLER AVE NE STE 116
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3459
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Country | US
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Telephone | 616-208-5256
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Fax | 616-226-4838
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Provider Business Mailing Address
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Address Line | 2922 FULLER AVE NE STE 116
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-3459
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Country | US
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Telephone | 616-208-5256
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Fax | 616-226-4838
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL DUHON
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Credential | LPC
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Telephone | 616-208-5256
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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 |
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License Number State |
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