Provider Demographics
NPI:1073209268
Name:ALLEN, ERICA R (PHD, DPC, NCC, LPC)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD, DPC, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:MS
Mailing Address - Zip Code:39146-0447
Mailing Address - Country:US
Mailing Address - Phone:662-528-0300
Mailing Address - Fax:
Practice Address - Street 1:240 N 2ND ST
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:MS
Practice Address - Zip Code:39146-1205
Practice Address - Country:US
Practice Address - Phone:662-528-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2990101YP2500X
MSP-0687101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty