Individual
MR. MARK S WALSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
967 SPAULDING AVE SE, SUITE E, ADA, MI 49301-3700
(616) 633-2170
Mailing address
967 SPAULDING AVE SE, SUITE E, ADA, MI 49301-3700
(616) 633-2170
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401003116
MI
Other
Enumeration date
11/28/2006
Last updated
01/26/2009
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