Provider Demographics
NPI:1295066355
Name:ESTES WATSON, ERICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ESTES WATSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 CHURCH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3624
Mailing Address - Country:US
Mailing Address - Phone:847-492-1938
Mailing Address - Fax:847-492-5081
Practice Address - Street 1:1007 CHURCH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3624
Practice Address - Country:US
Practice Address - Phone:847-492-1938
Practice Address - Fax:847-492-5081
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional