Provider Demographics
NPI:1396022174
Name:HERRING, ELIZABETH (LMSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:HERRING
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3821
Mailing Address - Country:US
Mailing Address - Phone:248-789-9509
Mailing Address - Fax:
Practice Address - Street 1:415 S WEST ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2521
Practice Address - Country:US
Practice Address - Phone:248-256-5977
Practice Address - Fax:248-256-5976
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010806171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932450566OtherNPI