Provider Demographics
NPI:1619380565
Name:SMITH, ERICA LEA (LMHC, CPC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LEA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC, CPC
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:LEA
Other - Last Name:EVERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:701 N PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2400
Mailing Address - Country:US
Mailing Address - Phone:702-455-4390
Mailing Address - Fax:850-469-3664
Practice Address - Street 1:701 N PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2400
Practice Address - Country:US
Practice Address - Phone:702-455-4390
Practice Address - Fax:702-388-2034
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCPC0219101YM0800X
FLMH12473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012097000Medicaid