Provider Demographics
NPI:1457822009
Name:ERICKSON, MARGARET ANN (LPCC, LADC)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:LPCC, LADC
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:ISTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 E 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1426
Mailing Address - Country:US
Mailing Address - Phone:952-956-3148
Mailing Address - Fax:612-869-3223
Practice Address - Street 1:1100 E 80TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1426
Practice Address - Country:US
Practice Address - Phone:952-956-3148
Practice Address - Fax:612-869-3223
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303557101YA0400X
MNCC01139101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)