Provider Demographics
NPI:1629746235
Name:LEADBETTER, CHRISTINE (LPCC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LEADBETTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 SPARKS DR SE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6159
Mailing Address - Country:US
Mailing Address - Phone:517-492-0784
Mailing Address - Fax:
Practice Address - Street 1:3950 SPARKS DR SE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6159
Practice Address - Country:US
Practice Address - Phone:517-492-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401224584101YP2500X
MI6451019445101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional