Provider Demographics
NPI:1144773078
Name:LERMA, QUENTON JOSEPH (LLMSW)
Entity type:Individual
Prefix:
First Name:QUENTON
Middle Name:JOSEPH
Last Name:LERMA
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 REMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3991
Mailing Address - Country:US
Mailing Address - Phone:517-348-7301
Mailing Address - Fax:
Practice Address - Street 1:2875 NORTHWIND DR
Practice Address - Street 2:SUITE 215
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5092
Practice Address - Country:US
Practice Address - Phone:517-348-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801099901101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)