Provider Demographics
NPI:1093055386
Name:COLLINS, ERICA MARIE (CHT)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:MARIE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2855
Mailing Address - Country:US
Mailing Address - Phone:513-424-4730
Mailing Address - Fax:513-424-4730
Practice Address - Street 1:7400 LIBERTY ONE DR
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-8874
Practice Address - Country:US
Practice Address - Phone:513-424-4730
Practice Address - Fax:513-424-4730
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103116103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst