Provider Demographics
NPI:1275010217
Name:WAKEFIELD, ERIN
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:WAKEFIELD
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 1:7745 BALLANTYNE COMMONS PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2442
Mailing Address - Country:US
Mailing Address - Phone:704-995-0342
Mailing Address - Fax:704-943-0707
Practice Address - Street 1:7745 BALLANTYNE COMMONS PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2442
Practice Address - Country:US
Practice Address - Phone:704-995-0342
Practice Address - Fax:704-943-0707
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NCA17306101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA17306OtherLICENSED CLINICAL MENTAL HEALTH ASSOCIATE
GAAPC007463OtherLICENSED PROFESSIONAL COUNSELOR ASSOCIATE