Provider Demographics
NPI:1205633161
Name:CREDA PLLC
Entity type:Organization
Organization Name:CREDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:GIBSON
Authorized Official - Last Name:FRANCISCOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:616-295-0691
Mailing Address - Street 1:977 ADA PLACE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3793
Mailing Address - Country:US
Mailing Address - Phone:616-295-0691
Mailing Address - Fax:
Practice Address - Street 1:977 ADA PLACE DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3793
Practice Address - Country:US
Practice Address - Phone:616-295-0691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty