Healthcare Provider Details

I. General information

NPI: 1285884635
Provider Name (Legal Business Name): ERICA C ERNST LCSW, RDDP, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 RIDGE AVE 301
EVANSTON IL
60201-5918
US

IV. Provider business mailing address

1740 RIDGE AVE 301
EVANSTON IL
60201-5918
US

V. Phone/Fax

Practice location:
  • Phone: 773-425-1151
  • Fax:
Mailing address:
  • Phone: 773-425-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.014574
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number28920
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29747
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number000519553
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: