Individual
MISS LISA MARIE BOOMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
1215 FULTON ST E, GRAND RAPIDS, MI 49503-3849
(616) 742-0351
Mailing address
1800 W MAIN ST LOT 56, LOWELL, MI 49331-1547
(616) 901-0401
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6401017408
MI
Other
Enumeration date
05/16/2016
Last updated
04/02/2020
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