Individual
MRS. ANDREA JOYCE DATTADEEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
2400 EASTERN AVE SE, GRAND RAPIDS, MI 49507-3632
(616) 988-3433
(313) 899-7087
Mailing address
194 W 18TH ST, HOLLAND, MI 49423-4123
(616) 510-8291
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401015974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401015974
STATE THERAPIST LICENSE
MI
Enumeration date
06/12/2017
Last updated
06/12/2017
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