Provider Demographics
NPI:1518677202
Name:WHITAKER, ERICA NERIECE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NERIECE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NERIECE
Other - Last Name:ARMSTEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1718 FAIRLAMB AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3720
Mailing Address - Country:US
Mailing Address - Phone:706-945-0151
Mailing Address - Fax:
Practice Address - Street 1:6 CALENDAR CT STE 4
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4715
Practice Address - Country:US
Practice Address - Phone:706-945-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty