Basic Information
| Provider Information | |||||||||
| NPI: | 1932843935 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 1 VERSE COUNSELING AND CONSULTING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6650 AVALON DR SE | ||||||||
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| City: | CALEDONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493167970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169143535 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1345 MONROE AVE NW STE 335 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495054699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162380074 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2022 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | MORRIS | ||||||||
| AuthorizedOfficialFirstName: | ARDRACE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6162380074 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA, MS, TLLP | ||||||||
| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.