Provider Demographics
NPI:1558638387
Name:CALHOUN, ERIC BERNARD (CACM)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BERNARD
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:CACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13575 LESURE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3131
Mailing Address - Country:US
Mailing Address - Phone:313-493-4410
Mailing Address - Fax:313-493-4415
Practice Address - Street 1:13575 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3131
Practice Address - Country:US
Practice Address - Phone:313-493-4410
Practice Address - Fax:313-493-4415
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821426101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)