Provider Demographics
NPI:1023157161
Name:CENTER FOR FAMILY DEVELOPMENT
Entity type:Organization
Organization Name:CENTER FOR FAMILY DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAULO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-392-7695
Mailing Address - Street 1:217 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6669
Mailing Address - Country:US
Mailing Address - Phone:616-392-7695
Mailing Address - Fax:616-392-6955
Practice Address - Street 1:347 HOOVER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5802
Practice Address - Country:US
Practice Address - Phone:616-392-7695
Practice Address - Fax:616-392-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YM0800X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty