Individual
TERESA SOFIA ELAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
TLLP
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503
(616) 256-3174
(616) 827-0762
Mailing address
3701 HERON AVE SW, WYOMING, MI 49509
(616) 304-0465
(616) 827-0762
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
6362002072
MI
Other
Enumeration date
07/10/2020
Last updated
07/10/2020
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