Provider Demographics
NPI:1386836294
Name:CINGLIE, COURTNEY RENE (LMSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENE
Last Name:CINGLIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:RENE
Other - Last Name:RUOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:1115 BALL AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4304
Mailing Address - Country:US
Mailing Address - Phone:616-495-7215
Mailing Address - Fax:616-451-9929
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-495-7215
Practice Address - Fax:616-451-0020
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010862161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381358001OtherAPPLICATION PENDING