Organization
THE BLOSSOM COUNSELING CENTER FOR PERSONAL GROWTH AND DEVELOPMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAYNE DELANA MCNICHOLS LMSW (THERAPIST)
(616) 284-1138
Entity
Organization
Contact information
Practice address
4829 E BELTLINE AVE NE STE 101, GRAND RAPIDS, MI 49525-9349
(616) 284-1138
Mailing address
5110 28TH ST SE # 1145, GRAND RAPIDS, MI 49512-2049
(616) 284-1138
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/15/2026
Last updated
01/15/2026
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