Provider Demographics
NPI:1558072397
Name:KOLBERG, WILLIAM CARL (PEER RECOVERY COACH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARL
Last Name:KOLBERG
Suffix:
Gender:M
Credentials:PEER RECOVERY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-0203
Mailing Address - Country:US
Mailing Address - Phone:616-265-4264
Mailing Address - Fax:
Practice Address - Street 1:913 W HOLMES RD STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0411
Practice Address - Country:US
Practice Address - Phone:517-887-0226
Practice Address - Fax:517-887-8121
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist