Basic Information
| Provider Information | |||||||||
| NPI: | 1073866497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENHEIMER | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3950 S ROCHESTER RD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488446234 | ||||||||
| FaxNumber: | 2488446237 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 S ROCHESTER RD | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | ROCHESTER HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483075160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488446234 | ||||||||
| FaxNumber: | 2488446237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2012 | ||||||||
| LastUpdateDate: | 10/23/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801080094 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6801080094 | 01 | MI | STATE OF MICHIGAN DEPT OF LICENSING AND REGULATORY AFFAIRS BOARD OF SOCIAL WORK | OTHER |