Provider Demographics
NPI:1386001543
Name:BANDA, ERICA (LCDC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:BANDA
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 PAREDES LINE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2244
Mailing Address - Country:US
Mailing Address - Phone:956-621-0442
Mailing Address - Fax:956-621-0293
Practice Address - Street 1:142 PAREDES LINE RD
Practice Address - Street 2:SUITE E
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2244
Practice Address - Country:US
Practice Address - Phone:956-621-0442
Practice Address - Fax:956-621-0293
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10387101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)