Provider Demographics
NPI:1174946578
Name:ENZ, ERICA (LMSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ENZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 4TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE ODESSA
Mailing Address - State:MI
Mailing Address - Zip Code:48849-1038
Mailing Address - Country:US
Mailing Address - Phone:616-210-3300
Mailing Address - Fax:
Practice Address - Street 1:911 4TH AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAKE ODESSA
Practice Address - State:MI
Practice Address - Zip Code:48849-1038
Practice Address - Country:US
Practice Address - Phone:616-210-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010942881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical