Provider Demographics
NPI:1295620300
Name:THOMPSON, GRACE (MDIV, LLMSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MDIV, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 CHICAGO DR STE 205
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-1411
Mailing Address - Country:US
Mailing Address - Phone:616-426-9034
Mailing Address - Fax:
Practice Address - Street 1:170 COLLEGE AVE STE 310
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2982
Practice Address - Country:US
Practice Address - Phone:616-426-9034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511183751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical