Healthcare Provider Details

I. General information

NPI: 1770097024
Provider Name (Legal Business Name): ERICA YAKER, LMSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2017
Last Update Date: 11/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 TELEGRAPH RD STE 252
BINGHAM FARMS MI
48025-3414
US

IV. Provider business mailing address

4470 APPLE VALLEY LN
W BLOOMFIELD MI
48323-2806
US

V. Phone/Fax

Practice location:
  • Phone: 248-914-1707
  • Fax:
Mailing address:
  • Phone: 248-914-1707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680108791
License Number StateMI

VIII. Authorized Official

Name: ERICA YAKER
Title or Position: CLINICAL SOCIAL WORK THERAPIST
Credential: LMSW
Phone: 248-914-1707