Provider Demographics
NPI:1962917385
Name:ERIKS, ANDREA (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ERIKS
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1313
Mailing Address - Country:US
Mailing Address - Phone:419-348-7995
Mailing Address - Fax:
Practice Address - Street 1:51728 INDIANA 933
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-4663
Practice Address - Country:US
Practice Address - Phone:419-348-7995
Practice Address - Fax:419-348-7995
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000361A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty