Healthcare Provider Details

I. General information

NPI: 1780360792
Provider Name (Legal Business Name): ERIKA CRENSHAW LMSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 WEALTHY ST SE
GRAND RAPIDS MI
49506-2717
US

IV. Provider business mailing address

4459 BREMER ST SW
GRANDVILLE MI
49418-2236
US

V. Phone/Fax

Practice location:
  • Phone: 616-881-9535
  • Fax:
Mailing address:
  • Phone: 616-443-2464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERIKA CRENSHAW
Title or Position: OWNER/OPERATOR
Credential: LMSW
Phone: 616-443-2464