Healthcare Provider Details

I. General information

NPI: 1386356483
Provider Name (Legal Business Name): ERIN MARIE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N WEBER ST
COLORADO SPRINGS CO
80903-5927
US

IV. Provider business mailing address

678 SAN JUAN RD
COLORADO SPRINGS CO
80904-2864
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-5458
  • Fax:
Mailing address:
  • Phone: 719-502-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADDC.0000823
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC.0025426
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: