Provider Demographics
NPI:1457080848
Name:HALTON, LAERICA
Entity Type:Individual
Prefix:
First Name:LAERICA
Middle Name:
Last Name:HALTON
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 1:25701 N LAKELAND BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2453
Mailing Address - Country:US
Mailing Address - Phone:949-500-3155
Mailing Address - Fax:
Practice Address - Street 1:25701 N LAKELAND BLVD STE 403
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2453
Practice Address - Country:US
Practice Address - Phone:949-500-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No104100000XBehavioral Health & Social Service ProvidersSocial Worker