Provider Demographics
NPI:1558047043
Name:JOHNSON-WHITE, ERICKA S (,MSW, LSW)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:S
Last Name:JOHNSON-WHITE
Suffix:
Gender:F
Credentials:,MSW, LSW
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:S
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:,MSW, LSW
Mailing Address - Street 1:10 S RIVERSIDE PLZ STE 875
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3717
Mailing Address - Country:US
Mailing Address - Phone:833-427-2264
Mailing Address - Fax:
Practice Address - Street 1:10 S RIVERSIDE PLZ STE 875
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-3717
Practice Address - Country:US
Practice Address - Phone:833-427-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150107606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker