Organization
VIDA WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECA E DAVILA LAC, LMSW (OWNER)
(773) 987-1357
Entity
Organization
Contact information
Practice address
3167 KALAMAZOO AVE SE STE 205, GRAND RAPIDS, MI 49508-1475
(773) 987-1357
(616) 414-8530
Mailing address
822 CASS AVE SE, GRAND RAPIDS, MI 49507-1116
(773) 987-1357
(616) 414-8530
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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