Provider Demographics
NPI:1346756632
Name:DALLAS, ERICA (ERICA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DALLAS
Suffix:
Gender:F
Credentials:ERICA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:D
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27510 SENNA CT
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6111
Mailing Address - Country:US
Mailing Address - Phone:216-536-6981
Mailing Address - Fax:
Practice Address - Street 1:27510 SENNA CT
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-6111
Practice Address - Country:US
Practice Address - Phone:216-536-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-21
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-05280106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician