Provider Demographics
NPI:1598114894
Name:MASSELINK, SANDRA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:MASSELINK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 68TH STREET SE
Mailing Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-795-1148
Mailing Address - Fax:
Practice Address - Street 1:300 68TH STREET SE
Practice Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548
Practice Address - Country:US
Practice Address - Phone:616-795-1148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010936491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical