Provider Demographics
NPI:1477712628
Name:BLACK, ERICA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 W USTICK RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6133
Mailing Address - Country:US
Mailing Address - Phone:208-366-1601
Mailing Address - Fax:208-366-1602
Practice Address - Street 1:750 W USTICK RD
Practice Address - Street 2:SUITE 120
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6133
Practice Address - Country:US
Practice Address - Phone:208-366-1601
Practice Address - Fax:208-366-1602
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2014-12-18
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health