Provider Demographics
NPI:1477983146
Name:E.R.I.C.'S: A PLACE FOR ANGELS
Entity Type:Organization
Organization Name:E.R.I.C.'S: A PLACE FOR ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-602-5191
Mailing Address - Street 1:6901 CHIPPEWA DR
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1436
Mailing Address - Country:US
Mailing Address - Phone:410-602-5191
Mailing Address - Fax:
Practice Address - Street 1:6901 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:21209-1436
Practice Address - Country:US
Practice Address - Phone:410-602-5191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health