Provider Demographics
NPI:1497862858
Name:WILLER, ERICA ROBERTA I (MC, LMFT, CAP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROBERTA
Last Name:WILLER
Suffix:I
Gender:F
Credentials:MC, LMFT, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3457 BROOK CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8181
Mailing Address - Country:US
Mailing Address - Phone:401-474-2763
Mailing Address - Fax:
Practice Address - Street 1:3457 BROOK CROSSING DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8181
Practice Address - Country:US
Practice Address - Phone:401-474-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist