Provider Demographics
NPI:1326400359
Name:DAVIS, ERICKA JEANICE LAWTON (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:JEANICE LAWTON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 SCOTCHWOOD GLEN, UNIT 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4333
Mailing Address - Country:US
Mailing Address - Phone:941-447-3745
Mailing Address - Fax:
Practice Address - Street 1:6050 SCOTCHWOOD GLEN, UNIT 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4333
Practice Address - Country:US
Practice Address - Phone:941-447-3745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0-17-7709106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
14023759OtherCAQH