Individual
MS. MARTHA DORAN BURKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, NCC, CAADC,ADS
Contact information
Practice address
2424 BURTON ST SE STE 104, GRAND RAPIDS, MI 49546-4833
(616) 541-4211
Mailing address
2424 BURTON ST SE STE 104, GRAND RAPIDS, MI 49546-4833
(616) 542-4211
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C-00076
MI
101YP2500X
Professional Counselor
Primary
6401009140
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11806665
CAQH
—
01
—
5797
NATIONAL AURICULAR ACUDETOX ASSOCIATION ADS CERTIFICATE
—
01
—
6401009140
COUNSELING LICENSE
MI
01
—
95289
NCC
—
01
—
C-00076
CAADC
MI
Enumeration date
12/01/2007
Last updated
08/27/2019
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