Individual
CHARLENE MARIE HARABURDA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA, LLP, RSW
Contact information
Practice address
243 68TH ST SE, GRAND RAPIDS, MI 49548-6924
(616) 222-5180
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301010951
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P10D112750
BC/BS
MA
Enumeration date
06/19/2006
Last updated
07/08/2007
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