Healthcare Provider Details

I. General information

NPI: 1538815204
Provider Name (Legal Business Name): ERIKA MARIE GRANT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 S LINDEN RD STE 200
FLINT MI
48532-4073
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-2320
  • Fax:
Mailing address:
  • Phone: 616-840-8000
  • Fax: 616-840-9642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004574
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6351004574
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: