Provider Demographics
NPI:1689147290
Name:SMITH, EMILY ERIN (LCPC CADC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ERIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 W ADAMS ST UNIT 360
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3090
Mailing Address - Country:US
Mailing Address - Phone:708-490-9399
Mailing Address - Fax:
Practice Address - Street 1:134 NORTH LASALLE STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1000
Practice Address - Country:US
Practice Address - Phone:847-493-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL24200101YA0400X
IL180004843101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)