Healthcare Provider Details

I. General information

NPI: 1407497829
Provider Name (Legal Business Name): ELIZABETH ANN MARIE ATWOOD CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN MARIE LEWIS

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W HOLMES RD STE 189
LANSING MI
48910-0434
US

IV. Provider business mailing address

913 W HOLMES RD STE 189
LANSING MI
48910-0434
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-4357
  • Fax:
Mailing address:
  • Phone: 517-272-4357
  • Fax: 517-798-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2-02168
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: