Provider Demographics
NPI:1861629263
Name:HAVEMAN, LINDA SUE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:HAVEMAN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 RAIN TREE AVE
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8481
Mailing Address - Country:US
Mailing Address - Phone:616-862-9828
Mailing Address - Fax:
Practice Address - Street 1:3260 EAGLE PARK DR NE
Practice Address - Street 2:SUITE 117
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4569
Practice Address - Country:US
Practice Address - Phone:616-530-2224
Practice Address - Fax:616-825-6164
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011380101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional