Provider Demographics
NPI:1336617927
Name:DOORLAG, BARBARA ANITA (LLP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANITA
Last Name:DOORLAG
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 KENEBERRY WAY SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3511
Mailing Address - Country:US
Mailing Address - Phone:616-581-8537
Mailing Address - Fax:
Practice Address - Street 1:1703 S DESPELDER ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2649
Practice Address - Country:US
Practice Address - Phone:616-581-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012955103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling