Provider Demographics
NPI:1912996844
Name:ERICKSON-LOUCKS, CONSTANCE (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:
Last Name:ERICKSON-LOUCKS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E JEFFERSON BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1922
Mailing Address - Country:US
Mailing Address - Phone:574-232-2255
Mailing Address - Fax:574-287-9377
Practice Address - Street 1:105 E JEFFERSON BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1922
Practice Address - Country:US
Practice Address - Phone:574-232-2255
Practice Address - Fax:574-287-9377
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000308A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical