Provider Demographics
NPI:1649741646
Name:WADFORD, ERIKA (BA)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:WADFORD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 CORDIAL LN APT 306
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3368
Mailing Address - Country:US
Mailing Address - Phone:184-383-0444
Mailing Address - Fax:
Practice Address - Street 1:14535 CORDIAL LN APT 306
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3368
Practice Address - Country:US
Practice Address - Phone:843-513-0964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NCBACB475185106S00000X
NC1-21-46964103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNONEMedicaid