Provider Demographics
NPI:1740818509
Name:WEAVER, ERIC THOMAS (LPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:THOMAS
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 44TH ST SE # 69972
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5096
Mailing Address - Country:US
Mailing Address - Phone:330-420-5655
Mailing Address - Fax:
Practice Address - Street 1:2744 CASTLE BLUFF CT SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-8083
Practice Address - Country:US
Practice Address - Phone:330-420-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-29
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401015567OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS