Provider Demographics
NPI:1912057795
Name:SENINS, SANDRA MARIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:SENINS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JEFFERSON AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4304
Mailing Address - Country:US
Mailing Address - Phone:616-456-1443
Mailing Address - Fax:616-732-6392
Practice Address - Street 1:601 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1871
Practice Address - Country:US
Practice Address - Phone:616-522-0846
Practice Address - Fax:616-522-0841
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009789101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor