Healthcare Provider Details

I. General information

NPI: 1639627920
Provider Name (Legal Business Name): ERICA ELIZABETH RUSSELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA ELIZABETH SEHLING

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 08/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 E PARIS AVE SE
GRAND RAPIDS MI
49546-2426
US

IV. Provider business mailing address

2275 FAWNWOOD DR SE
KENTWOOD MI
49508-6519
US

V. Phone/Fax

Practice location:
  • Phone: 616-481-3784
  • Fax:
Mailing address:
  • Phone: 586-945-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401015661
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: