Healthcare Provider Details

I. General information

NPI: 1306033238
Provider Name (Legal Business Name): ERIKA INGRID OLIVER MA, LLP, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/21/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PLYMOUTH AVE. NE
GRAND RAPIDS MI
49505
US

IV. Provider business mailing address

416 PLYMOUTH AVE. NE
GRAND RAPIDS MI
49505
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-6484
  • Fax: 616-228-4959
Mailing address:
  • Phone: 616-202-6484
  • Fax: 616-228-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301013660
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: