Organization
RIVERSIDE COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BONNIE J DYKSTRA PH.D (CLINICAL PSYCHOLOGIST)
(989) 274-7219
Entity
Organization
Contact information
Practice address
8618 BROWER LAKE DR NE, ROCKFORD, MI 49341-8320
(989) 274-7219
Mailing address
8618 BROWER LAKE DR NE, ROCKFORD, MI 49341-8320
(989) 274-7219
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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