Provider Demographics
NPI:1669864427
Name:DESAUSSURE, ERICA NECOLE (MS)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:NECOLE
Last Name:DESAUSSURE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 CALLIE CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-1567
Mailing Address - Country:US
Mailing Address - Phone:407-721-9595
Mailing Address - Fax:
Practice Address - Street 1:1630 CALLIE CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-1567
Practice Address - Country:US
Practice Address - Phone:407-721-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2127106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist