Provider Demographics
NPI:1679177919
Name:ERAWAN COUNSELING, LLC
Entity Type:Organization
Organization Name:ERAWAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:DE JONG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, LMHC
Authorized Official - Phone:708-710-3696
Mailing Address - Street 1:427 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2223
Mailing Address - Country:US
Mailing Address - Phone:708-710-3696
Mailing Address - Fax:
Practice Address - Street 1:427 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2223
Practice Address - Country:US
Practice Address - Phone:708-710-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty