Provider Demographics
NPI:1235763681
Name:CLINTON, ERIKA DAWN
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:DAWN
Last Name:CLINTON
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 1:11215 HERMITAGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-3864
Mailing Address - Country:US
Mailing Address - Phone:501-436-3991
Mailing Address - Fax:
Practice Address - Street 1:11215 HERMITAGE RD STE 201
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3864
Practice Address - Country:US
Practice Address - Phone:501-436-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician