Provider Demographics
NPI:1073909842
Name:REDDICK, EREKA
Entity Type:Individual
Prefix:
First Name:EREKA
Middle Name:
Last Name:REDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-2411
Mailing Address - Country:US
Mailing Address - Phone:850-875-0075
Mailing Address - Fax:850-627-2614
Practice Address - Street 1:116 N MADISON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-2411
Practice Address - Country:US
Practice Address - Phone:850-875-0075
Practice Address - Fax:850-627-2614
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator