Provider Demographics
NPI:1033749825
Name:ERICA D. PRINCE, PHD, LLC
Entity Type:Organization
Organization Name:ERICA D. PRINCE, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-753-8684
Mailing Address - Street 1:2945 NW MULKEY AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1836
Mailing Address - Country:US
Mailing Address - Phone:541-753-8684
Mailing Address - Fax:541-752-0906
Practice Address - Street 1:2945 NW MULKEY AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-1836
Practice Address - Country:US
Practice Address - Phone:541-753-8684
Practice Address - Fax:541-752-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health