Provider Demographics
NPI:1689552200
Name:ERICKSON, SARA J (MA, LPCC, CCTP, CGP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:J
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MA, LPCC, CCTP, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 W 78TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2649
Mailing Address - Country:US
Mailing Address - Phone:770-261-2582
Mailing Address - Fax:
Practice Address - Street 1:220 ROBERT ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1677
Practice Address - Country:US
Practice Address - Phone:763-878-6554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2743101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional