Provider Demographics
NPI:1689186827
Name:LASTRES, ERIN MARIE (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:LASTRES
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 1:2055 W ARMY TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1478
Mailing Address - Country:US
Mailing Address - Phone:630-580-3190
Mailing Address - Fax:
Practice Address - Street 1:2055 W ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1478
Practice Address - Country:US
Practice Address - Phone:630-580-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-27
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL30869101YA0400X
IL180.009646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)