Provider Demographics
NPI:1043491475
Name:WADE, ERICA D (PHD, LCPC, ACS)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:D
Last Name:WADE
Suffix:
Gender:F
Credentials:PHD, LCPC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 FAIRFAX CIR E UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-7484
Mailing Address - Country:US
Mailing Address - Phone:815-901-3769
Mailing Address - Fax:
Practice Address - Street 1:155 N WACKER DR STE 4250
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1750
Practice Address - Country:US
Practice Address - Phone:312-262-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-006666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180006666OtherLCPC