Provider Demographics
NPI:1073938841
Name:EVERLY, ERIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:EVERLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OGLESBY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4616
Mailing Address - Country:US
Mailing Address - Phone:815-370-5466
Mailing Address - Fax:
Practice Address - Street 1:706 OGLESBY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4616
Practice Address - Country:US
Practice Address - Phone:815-370-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker