Individual
KIRSTI VICKERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2814 WOODCLIFF CIR SE, GRAND RAPIDS, MI 49506-3155
(989) 884-4174
Mailing address
214 MASON ST, SPRING LAKE, MI 49456-1665
(989) 884-4174
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
08/01/2018
Last updated
02/28/2021
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