Provider Demographics
NPI:1215385869
Name:ZANISH, ERICA (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ZANISH
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10077 DOGWOOD ST NW
Mailing Address - Street 2:SUITE 200, #201
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5286
Mailing Address - Country:US
Mailing Address - Phone:763-489-7124
Mailing Address - Fax:763-489-7498
Practice Address - Street 1:10077 DOGWOOD ST NW
Practice Address - Street 2:SUITE 200, #201
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5286
Practice Address - Country:US
Practice Address - Phone:763-489-7124
Practice Address - Fax:763-489-7498
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional