Provider Demographics
NPI:1821696790
Name:BEATTIE, ERICA WINDLER (LLMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:WINDLER
Last Name:BEATTIE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4745
Mailing Address - Country:US
Mailing Address - Phone:336-501-5485
Mailing Address - Fax:
Practice Address - Street 1:5123 W ST JOE HWY STE 103
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4028
Practice Address - Country:US
Practice Address - Phone:517-323-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011081951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical