Healthcare Provider Details

I. General information

NPI: 1215823612
Provider Name (Legal Business Name): ERICA LATHION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10208 S INDIANAPOLIS AVE STE 301
CHICAGO IL
60617-6033
US

IV. Provider business mailing address

12324 S ABERDEEN ST
CALUMET PARK IL
60827-5804
US

V. Phone/Fax

Practice location:
  • Phone: 866-413-1988
  • Fax: 866-628-8599
Mailing address:
  • Phone: 773-354-1779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number30570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: