Individual
LISA S. DEITERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
503 CENTURY LN STE 2, HOLLAND, MI 49423-4318
(616) 730-1556
Mailing address
503 CENTURY LN STE 2, HOLLAND, MI 49423-4318
(616) 730-1556
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6401009532
MI
101YP2500X
Professional Counselor
6401009532
MI
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538477328
—
MI
Enumeration date
09/15/2010
Last updated
05/06/2026
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