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General NPI Number Information
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NPI Number | 1003316449
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Entity Type | Individual
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Provider Name | ERIN RACHEL HENDRICKSON MAC, LPC
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Gender | Female
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 02/12/2018
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Provider Practice Location Address
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Address Line | 1300 HAMPTON AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-3138
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Country | US
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Telephone | 314-913-3691
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Fax |
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Provider Business Mailing Address
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Address Line | 686 RUSTIC VALLEY DR
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City | BALLWIN
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State | MO
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Zip | 63021-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2016013594
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License Number State | MO
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