Individual
ERICA ELIZABETH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2305 E PARIS AVE SE, GRAND RAPIDS, MI 49546-2426
(616) 481-3784
Mailing address
2275 FAWNWOOD DR SE, KENTWOOD, MI 49508-6519
(586) 945-5313
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401015661
MI
Other
Enumeration date
09/14/2016
Last updated
08/10/2019
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