Provider Demographics
NPI:1164020558
Name:MCALISTER, DANITA
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:
Last Name:MCALISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 SIGSBEE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-2555
Mailing Address - Country:US
Mailing Address - Phone:616-773-1195
Mailing Address - Fax:
Practice Address - Street 1:2504 NORMANDY DR SE APT 213B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-7901
Practice Address - Country:US
Practice Address - Phone:616-773-1195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018563101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor