Provider Demographics
NPI:1629700109
Name:BLANKS, ERICA (LPC)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:
Last Name:BLANKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10828 SAINT CHARLES ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-1508
Mailing Address - Country:US
Mailing Address - Phone:314-368-2409
Mailing Address - Fax:314-442-4139
Practice Address - Street 1:10828 SAINT CHARLES ROCK RD
Practice Address - Street 2:
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-1508
Practice Address - Country:US
Practice Address - Phone:314-368-2409
Practice Address - Fax:314-442-4139
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021032886101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021032886Medicaid