Organization
FAMILY WHOLENESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA DYKSTRA LPN, NCC, CAADC (OWNER)
(616) 920-1892
Entity
Organization
Contact information
Practice address
800 MONROE AVE NW, STE 202, GRAND RAPIDS, MI 49503
(214) 212-2703
Mailing address
1680 44TH ST SE UNIT 88333, GRAND RAPIDS, MI 49518-5050
(214) 212-2703
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
06/21/2022
Last updated
08/29/2022
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