Provider Demographics
NPI:1508311796
Name:BLUNTSON, ERIKA KRISTEN
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:KRISTEN
Last Name:BLUNTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2642 LITTLE HILL CV APT 114
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6668
Mailing Address - Country:US
Mailing Address - Phone:239-410-6803
Mailing Address - Fax:
Practice Address - Street 1:2500 MAITLAND CENTER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4174
Practice Address - Country:US
Practice Address - Phone:407-630-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health