Provider Demographics
NPI:1578120887
Name:CULLUM, ERIN (LLPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:CULLUM
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3842 STUYVESANT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2228
Mailing Address - Country:US
Mailing Address - Phone:616-951-2580
Mailing Address - Fax:
Practice Address - Street 1:1651 W CENTRE AVE STE 203
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6313
Practice Address - Country:US
Practice Address - Phone:269-366-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty