Individual
LINDSEY AUTUMN DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
1000 MONROE AVE NW, GRAND RAPIDS, MI 49503-1455
(616) 259-7207
(616) 259-7261
Mailing address
1000 MONROE AVE NW, GRAND RAPIDS, MI 49503-1455
(616) 259-2707
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LPCC0015902
CO
101YP2500X
Professional Counselor
Primary
6401223229
MI
101YS0200X
School Counselor
LPCC0015902
CO
Other
Enumeration date
04/06/2018
Last updated
08/24/2023
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