Provider Demographics
NPI:1962243006
Name:LANE, ERIN (BSW, LLMSW)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:BSW, LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20109 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2311
Mailing Address - Country:US
Mailing Address - Phone:313-258-0859
Mailing Address - Fax:
Practice Address - Street 1:12703 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1302
Practice Address - Country:US
Practice Address - Phone:313-694-3886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511185521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical