Basic Information
| Provider Information | |||||||||
| NPI: | 1053674820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLEASANT-PROCTOR | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PLEASANT | ||||||||
| OtherFirstName: | JANICE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1939 S DIVISION AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1939 S DIVISION AVE. | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 05/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801094429 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.