Provider Demographics
NPI:1083935506
Name:HANSON, ERICA YVONNE (MS, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:YVONNE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3508 WESTMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6923
Mailing Address - Country:US
Mailing Address - Phone:701-261-7745
Mailing Address - Fax:
Practice Address - Street 1:211 HOLMES ST W STE 302
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-9905
Practice Address - Country:US
Practice Address - Phone:218-847-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01709101YP2500X
MN01709101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional