Provider Demographics
NPI:1649723297
Name:DREJA, ELIZABETH DANIELLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DANIELLE
Last Name:DREJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 E AMADOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3675
Mailing Address - Country:US
Mailing Address - Phone:575-520-6074
Mailing Address - Fax:
Practice Address - Street 1:2711 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4317
Practice Address - Country:US
Practice Address - Phone:616-540-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401002760103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst