Provider Demographics
NPI:1487822037
Name:POOLE, ERAINA ANN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ERAINA
Middle Name:ANN
Last Name:POOLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 E 5TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-767-0522
Mailing Address - Fax:810-767-0699
Practice Address - Street 1:225 E 5TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1641
Practice Address - Country:US
Practice Address - Phone:810-767-0522
Practice Address - Fax:810-767-0699
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801347991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
082695Medicare PIN