Provider Demographics
NPI:1508382037
Name:GAINES, ERICA SULLIVAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:SULLIVAN
Last Name:GAINES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BYRD WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-9195
Mailing Address - Country:US
Mailing Address - Phone:478-953-0330
Mailing Address - Fax:478-953-0368
Practice Address - Street 1:108 BYRD WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088
Practice Address - Country:US
Practice Address - Phone:478-953-0330
Practice Address - Fax:478-953-0368
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001420106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist