Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Other names
Pine Rest Community Services Substance Abuse
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M FENNEMA (MANAGED CARE ADMINISTRATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
320 COMMERCE AVE SW, GRAND RAPIDS, MI 49503-4101
(616) 258-7599
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6372
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103T00000X
Psychologist
—
—
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
283Q00000X
Psychiatric Hospital
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/09/2021
Last updated
03/11/2022
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