Provider Demographics
NPI:1316598550
Name:WOLD, ERIN DALE (LPC, NCC, PEL)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:DALE
Last Name:WOLD
Suffix:
Gender:F
Credentials:LPC, NCC, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 GLENWOOD AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5495
Mailing Address - Country:US
Mailing Address - Phone:815-730-7521
Mailing Address - Fax:815-730-7524
Practice Address - Street 1:2400 GLENWOOD AVE STE 126
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5495
Practice Address - Country:US
Practice Address - Phone:815-730-7521
Practice Address - Fax:815-730-7524
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.014560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional