Provider Demographics
NPI:1265004832
Name:PASS, ERRICKA K
Entity Type:Individual
Prefix:
First Name:ERRICKA
Middle Name:K
Last Name:PASS
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 1:2334 CREEKVIEW TRL
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3649
Mailing Address - Country:US
Mailing Address - Phone:678-769-0451
Mailing Address - Fax:
Practice Address - Street 1:2334 CREEKVIEW TRL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-3649
Practice Address - Country:US
Practice Address - Phone:678-769-0451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician