Provider Demographics
NPI:1780154435
Name:PRIME, ERICA GRIFFIS (LLP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:GRIFFIS
Last Name:PRIME
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28066 SUNSET BLVD W
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2658
Mailing Address - Country:US
Mailing Address - Phone:248-894-6981
Mailing Address - Fax:
Practice Address - Street 1:28066 SUNSET BLVD W
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2658
Practice Address - Country:US
Practice Address - Phone:248-894-6981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010024103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral