Provider Demographics
NPI:1629356175
Name:NIEBOER, RIA ANASTASIA (LMSW, CAADC, ADS)
Entity Type:Individual
Prefix:MRS
First Name:RIA
Middle Name:ANASTASIA
Last Name:NIEBOER
Suffix:
Gender:F
Credentials:LMSW, CAADC, ADS
Other - Prefix:MRS
Other - First Name:RIE
Other - Middle Name:
Other - Last Name:NIEBOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:926 WASHINGTON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7725
Mailing Address - Country:US
Mailing Address - Phone:616-820-3780
Mailing Address - Fax:616-820-3785
Practice Address - Street 1:926 WASHINGTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7725
Practice Address - Country:US
Practice Address - Phone:616-820-3780
Practice Address - Fax:616-820-3785
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health