Provider Demographics
NPI:1477041481
Name:SANFORD, ERIK MICHAEL
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:MICHAEL
Last Name:SANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 CRYSTAL LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-9306
Mailing Address - Country:US
Mailing Address - Phone:231-670-6580
Mailing Address - Fax:
Practice Address - Street 1:2412 CRYSTAL LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9306
Practice Address - Country:US
Practice Address - Phone:231-670-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker