Provider Demographics
NPI:1548751993
Name:DAVIS, ERICA LEE (MS BCBA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEE
Other - Last Name:DUCHAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA
Mailing Address - Street 1:928 OSPREY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6401
Mailing Address - Country:US
Mailing Address - Phone:321-806-0510
Mailing Address - Fax:
Practice Address - Street 1:1535 W NASA BLVD UNIT C-1
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2614
Practice Address - Country:US
Practice Address - Phone:321-235-6199
Practice Address - Fax:321-821-1975
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-62504106S00000X
FLBACB449375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician