Provider Demographics
NPI:1134701774
Name:MADD HEALING AND LIFE COACHING
Entity Type:Organization
Organization Name:MADD HEALING AND LIFE COACHING
Other - Org Name:MADD HEALING AND LIFE COACHING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD-GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-719-7164
Mailing Address - Street 1:401 HALL ST SW STE 112J
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-6501
Mailing Address - Country:US
Mailing Address - Phone:616-719-7164
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SW STE 112J
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-6501
Practice Address - Country:US
Practice Address - Phone:616-719-7164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty