Provider Demographics
NPI:1861635088
Name:ERICKSON, ANDREA R (LMHC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TEN ROD ROAD
Mailing Address - Street 2:BLDG C201
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852
Mailing Address - Country:US
Mailing Address - Phone:401-294-8181
Mailing Address - Fax:401-294-9879
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:BLDG C201
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-294-8181
Practice Address - Fax:401-294-9879
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00330101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health