Active NPI
Sophia Dykstra, LPC, NCC, CAADC
- Counselor
- Grand Rapids, MI
National Provider Identifier
1649606716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 3300 36TH St SE
Grand Rapids, MI 49512-2810 - Phone
- (616) 942-2110
- NPI assigned
- Sep 20, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Professional Counselor | 101YP2500X | |||
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
3300 36TH St SE
Grand Rapids, MI 49512-2810
Mailing address
3300 36TH St SE
Grand Rapids, MI 49512-2810
Phone (616) 942-2110
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100163580A | Medicaid | IN |
Other names 1
- Sophia De Land
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Wholeness PLLC | Professional | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Grand Rapids, MI
- NPI 1790416881
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379635200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649203200000",
"number": "1649606716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122810",
"telephone_number": "616-942-2110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 36TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495122810",
"telephone_number": "616-942-2110"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DYKSTRA",
"first_name": "SOPHIA",
"credential": "LPC, NCC, CAADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-20",
"last_updated": "2022-04-06",
"certification_date": "2022-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100163580A",
"state": "IN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SOPHIA",
"last_name": "DE LAND",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.