| Intentional Life Counseling & Addictions Treatment Pllc | |
|
1444 Michigan St Ne Ste 3 Grand Rapids MI 49503-2028 | |
| (616) 734-9745 | |
| Not Available |
| Full Name | Intentional Life Counseling & Addictions Treatment Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1444 Michigan St Ne Ste 3, Grand Rapids, Michigan |
| Authorized Official Name and Position | Thavone Huinil (OWNER) |
| Authorized Official Contact | 6167349745 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intentional Life Counseling & Addictions Treatment Pllc 1444 Michigan St Ne Ste 3 Grand Rapids MI 49503-2028 Ph: () - | Intentional Life Counseling & Addictions Treatment Pllc 1444 Michigan St Ne Ste 3 Grand Rapids MI 49503-2028 Ph: (616) 734-9745 |
| NPI Number | 1912416181 |
|---|---|
| Provider Enumeration Date | 09/20/2017 |
| Last Update Date | 09/20/2017 |
| Medicare PECOS PAC ID | 7810238714 |
|---|---|
| Medicare Enrollment ID | O20190402001699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912416181 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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