Provider Demographics
NPI:1225487945
Name:EUBANKS, ERICA (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 HAVANA AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-3872
Mailing Address - Country:US
Mailing Address - Phone:616-334-8236
Mailing Address - Fax:
Practice Address - Street 1:3968 HAVANA AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-3872
Practice Address - Country:US
Practice Address - Phone:616-334-8236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011072271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical