Dykstra, Sophia

Dykstra, Sophia is an individual health care provider with primary practice located at 3300 36Th St Se , Grand Rapids MI 49512-2810. She recently has 4 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Professional, Behavioral Health & Social Service Providers / Counselor. Behavioral Health & Social Service Providers / Counselor is her primary health care specialty. Dykstra, Sophia can be contacted via phone (616) 942-2110.

Contact Information

Primary practice address
3300 36Th St Se Grand Rapids MI 49512-2810
Phone: (616) 942-2110
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Professional 101YP2500X
Behavioral Health & Social Service Providers / Counselor 101Y00000X

Profile Details

NPI number 1649606716
LBN Legal business name Dykstra, Sophia
Credentials LPC, NCC, CAADC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2013
Last updated Apr 6th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649606716 NPPES
Indiana MEDICAID 100163580A

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