Provider Demographics
NPI:1235351032
Name:BACON, ERIKA GORE (MA, ATR-BC, LCMHC)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:GORE
Last Name:BACON
Suffix:
Gender:F
Credentials:MA, ATR-BC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ROPE FERRY RD
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1404
Mailing Address - Country:US
Mailing Address - Phone:603-646-9442
Mailing Address - Fax:603-646-9450
Practice Address - Street 1:16 KINGSFORD RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2210
Practice Address - Country:US
Practice Address - Phone:603-643-6013
Practice Address - Fax:603-646-9450
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health