Provider Demographics
NPI:1326602590
Name:THE COTTAGE AT 933 LLC
Entity Type:Organization
Organization Name:THE COTTAGE AT 933 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:419-348-7995
Mailing Address - Street 1:51728 STATE ROAD 933
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-1706
Mailing Address - Country:US
Mailing Address - Phone:419-348-7995
Mailing Address - Fax:
Practice Address - Street 1:51728 STATE ROAD 933
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-1706
Practice Address - Country:US
Practice Address - Phone:419-348-7995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty