Provider Demographics
NPI:1891304713
Name:COMPREHENSIVE COUNSELING CTR
Entity Type:Organization
Organization Name:COMPREHENSIVE COUNSELING CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-589-4715
Mailing Address - Street 1:2021 44TH ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5349
Mailing Address - Country:US
Mailing Address - Phone:616-777-7399
Mailing Address - Fax:616-773-1383
Practice Address - Street 1:2021 44TH ST SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5349
Practice Address - Country:US
Practice Address - Phone:616-777-7399
Practice Address - Fax:616-773-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty