Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 071010114 | IL |
Y | 103T00000X | Psychologist | 071010114 | IL |
N | 102L00000X | Psychologist | 20043256A | IN |
N | 103T00000X | Psychologist | 20043256A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1033510185 |
---|---|
Provider Name | Dr. Adrian Ervington |
First Address | Champaign, IL 61820-7740 |
Second Address | Danville, IL 61832-5100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2014 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071010114 | LICENSED CLINICAL PSYCHOLOGIST (01) | IL |
20043256A | LICENSED CLINICAL PSYCHOLOGIST (01) | IN |