Provider Demographics
NPI:1780439653
Name:LICHTENWALTER, ERICH (LMSW)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:
Last Name:LICHTENWALTER
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 TIMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1430
Mailing Address - Country:US
Mailing Address - Phone:269-861-4287
Mailing Address - Fax:
Practice Address - Street 1:133 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-3607
Practice Address - Country:US
Practice Address - Phone:269-408-2258
Practice Address - Fax:989-352-6435
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011197951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical