Provider Demographics
NPI:1285985085
Name:ANDERSON, ERIK RYAN (LMSW (MI), LCSW (AZ))
Entity type:Individual
Prefix:MR
First Name:ERIK
Middle Name:RYAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMSW (MI), LCSW (AZ)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1357 E HESS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-8617
Mailing Address - Country:US
Mailing Address - Phone:734-883-8415
Mailing Address - Fax:734-822-0119
Practice Address - Street 1:1357 E HESS LAKE DR
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-8617
Practice Address - Country:US
Practice Address - Phone:734-883-8415
Practice Address - Fax:734-822-0199
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010954701041C0700X
AZ203181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical