Provider Demographics
NPI:1659786325
Name:DUBBA, ERIN (LCPC, ATR, MS, MA)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:DUBBA
Suffix:
Gender:F
Credentials:LCPC, ATR, MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELGIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1398
Mailing Address - Country:US
Mailing Address - Phone:312-508-3281
Mailing Address - Fax:
Practice Address - Street 1:405 ILLINOIS AVE UNIT 2C
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2963
Practice Address - Country:US
Practice Address - Phone:630-530-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-21
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008882101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health