Healthcare Provider Details

I. General information

NPI: 1033028949
Provider Name (Legal Business Name): ERIN K RADTKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47305 REENE DR
VAN BUREN TOWNSHIP MI
48111-1067
US

IV. Provider business mailing address

47305 REENE DR
VAN BUREN TOWNSHIP MI
48111-1067
US

V. Phone/Fax

Practice location:
  • Phone: 734-740-8993
  • Fax:
Mailing address:
  • Phone: 734-740-8993
  • Fax: 734-740-8993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008932
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: