Healthcare Provider Details

I. General information

NPI: 1689147290
Provider Name (Legal Business Name): EMILY ERIN SMITH LCPC. CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 NORTH LASALLE STREET SUITE 400
CHICAGO IL
60602-1000
US

IV. Provider business mailing address

1040 W ADAMS ST UNIT 360
CHICAGO IL
60607-3090
US

V. Phone/Fax

Practice location:
  • Phone: 847-493-3717
  • Fax:
Mailing address:
  • Phone: 708-490-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180004843
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number24200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: