Provider Demographics
NPI:1972041721
Name:COMMUNITY RECOVERY COUNSELING CENTER, PLLC
Entity Type:Organization
Organization Name:COMMUNITY RECOVERY COUNSELING CENTER, PLLC
Other - Org Name:CRCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WESSELS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-678-3622
Mailing Address - Street 1:1975 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2511
Mailing Address - Country:US
Mailing Address - Phone:616-678-3622
Mailing Address - Fax:616-678-3622
Practice Address - Street 1:1975 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2511
Practice Address - Country:US
Practice Address - Phone:616-678-3622
Practice Address - Fax:616-678-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012530251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health