Healthcare Provider Details

I. General information

NPI: 1346759412
Provider Name (Legal Business Name): ERIN MARIE PRINDIVILLE MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 07/21/2022
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4633 AICHOLTZ RD.
CINCINNATI OH
45244
US

IV. Provider business mailing address

4629 AICHOLTZ RD.
CINCINNATI OH
45244
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax:
Mailing address:
  • Phone: 513-520-2621
  • Fax: 513-688-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001680
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: