Provider Demographics
NPI:1194235994
Name:GROSSMAN, ERICA DANIELLE (MS, LPC INTERN, NCC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:MS, LPC INTERN, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 N MCKENNA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2651
Mailing Address - Country:US
Mailing Address - Phone:503-381-8530
Mailing Address - Fax:
Practice Address - Street 1:3537 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1437
Practice Address - Country:US
Practice Address - Phone:503-381-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health