Individual
WENDY LOU GORNICK-MAYCROFT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
640 3 MILE RD NW STE G, GRAND RAPIDS, MI 49544-8209
(800) 693-1916
Mailing address
221 RIVERFRONT ST APT 5, SPRING LAKE, MI 49456-2081
(989) 802-2263
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401012338
—
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
6401012338
MI
Other
Enumeration date
11/10/2006
Last updated
08/03/2022
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