Provider Demographics
NPI:1619935897
Name:ERICKSON, RAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 I ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4311
Mailing Address - Country:US
Mailing Address - Phone:916-333-4169
Mailing Address - Fax:916-333-4169
Practice Address - Street 1:241 W EL CAMINO AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-2245
Practice Address - Country:US
Practice Address - Phone:916-333-4169
Practice Address - Fax:916-333-4169
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health