Provider Demographics
NPI:1063893907
Name:GRACE HAVEN COUNSELING, LLC
Entity type:Organization
Organization Name:GRACE HAVEN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VANHARMELEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:616-780-0402
Mailing Address - Street 1:4565 WILSON AVE SW
Mailing Address - Street 2:STE. 4A
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2371
Mailing Address - Country:US
Mailing Address - Phone:616-745-2387
Mailing Address - Fax:616-432-3059
Practice Address - Street 1:4565 WILSON AVE SW
Practice Address - Street 2:STE. 4A
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2371
Practice Address - Country:US
Practice Address - Phone:616-745-2387
Practice Address - Fax:616-432-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010901521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty