Individual
AMANDA KUBIAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
(616) 456-6571
Mailing address
1115 BALL AVE NE, GRAND RAPIDS, MI 49505-5904
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
01/03/2019
Last updated
01/03/2019
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