Derek John Erickson, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

305050 Issued in MN

Practice address

3720 23Rd Ave S
Minneapolis, MN 55407-3010

Phone

(612) 272-6978

NPI assigned

Dec 9, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ascentium Counseling, LLC

  • Substance Abuse Rehabilitation Facility
  • Richfield, MN
  • NPI 1235805615
  NPD Authorized official
• Relentless Recovery LLC

  • Substance Abuse Rehabilitation Facility
  • Minneapolis, MN
  • NPI 1912877465
  NPD Authorized official
• Agape Counseling Center, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Windom, MN
  • NPI 1063744662
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1679044184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 9TH ST",
            "city": "WINDOM",
            "state": "MN",
            "postal_code": "561011658",
            "telephone_number": "507-832-8033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 23RD AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554073010",
            "telephone_number": "612-272-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "DEREK",
        "middle_name": "JOHN",
        "credential": "LADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-09",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "305050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britt Kristina Erickson, M.D.
• Carrie Lynn Erickson, OTR
• Christa Erickson, SLP
• Clinton Erickson II, RN
• Denise Rae Erickson, N.P.
• Hans Erickson
• Heather Erickson, MSW, LICSW
• Heather Mae Erickson, M.S., CCC-SLP
• Heidi Lynn Erickson, MD
• Jackie A Erickson, APRN,CRNA

• Addiction (Substance Use Disorder) Counselor in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.