Individual
ERIC S LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA,LLP, CADC
Contact information
Practice address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
(616) 840-9771
Mailing address
235 WEALTHY ST SE, GRAND RAPIDS, MI 49503-5247
(616) 840-8000
(616) 840-9771
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
121
NE
101YM0800X
Mental Health Counselor
8952
NE
103TC1900X
Counseling Psychologist
Primary
6361002966
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47082303526
—
NE
Enumeration date
09/18/2009
Last updated
03/06/2024
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