Provider Demographics
NPI:1770367054
Name:COUNCILMAN, ERIN H
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:H
Last Name:COUNCILMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 POMEROY RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-9478
Mailing Address - Country:US
Mailing Address - Phone:740-517-1224
Mailing Address - Fax:
Practice Address - Street 1:3 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-3717
Practice Address - Country:US
Practice Address - Phone:740-517-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities