Provider Demographics
NPI:1629377569
Name:ERICKSON-WORPEL, KIMBERLEE KAE (MA, LLP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:KAE
Last Name:ERICKSON-WORPEL
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 GRAND HAVEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5985
Mailing Address - Country:US
Mailing Address - Phone:231-799-8182
Mailing Address - Fax:231-799-8183
Practice Address - Street 1:5353 GRAND HAVEN RD STE B
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5985
Practice Address - Country:US
Practice Address - Phone:231-799-8182
Practice Address - Fax:231-799-8183
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014405103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling