Provider Demographics
NPI:1932586195
Name:WILCOME, SUSAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WILCOME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:360 E BELTLINE AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1214
Mailing Address - Country:US
Mailing Address - Phone:616-805-3660
Mailing Address - Fax:616-805-3631
Practice Address - Street 1:100 S GREENVILLE WEST DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-3572
Practice Address - Country:US
Practice Address - Phone:616-805-3660
Practice Address - Fax:616-805-3631
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015292101YP2500X
104100000X
MI6401018954101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker