Provider Demographics
NPI:1538703798
Name:WALDROP, ERICK VAN (LADC/MH COUNSELOR)
Entity Type:Individual
Prefix:MR
First Name:ERICK
Middle Name:VAN
Last Name:WALDROP
Suffix:
Gender:M
Credentials:LADC/MH COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 SE 66TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73149-5203
Mailing Address - Country:US
Mailing Address - Phone:405-616-3366
Mailing Address - Fax:405-616-4925
Practice Address - Street 1:1613 SE 66TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73149-5203
Practice Address - Country:US
Practice Address - Phone:405-616-3366
Practice Address - Fax:405-616-4925
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health