Provider Demographics
NPI:1619533577
Name:SARA MARIE RICE
Entity Type:Organization
Organization Name:SARA MARIE RICE
Other - Org Name:KOINONIA COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-208-9337
Mailing Address - Street 1:2566 22 MILE RD NW
Mailing Address - Street 2:
Mailing Address - City:KENT CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49330-9203
Mailing Address - Country:US
Mailing Address - Phone:616-208-9337
Mailing Address - Fax:616-208-9337
Practice Address - Street 1:3500 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-3260
Practice Address - Country:US
Practice Address - Phone:616-208-9337
Practice Address - Fax:616-208-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
14470467OtherCAQH