Provider Demographics
NPI:1700378247
Name:ROBERSON, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SENTEL LN
Mailing Address - Street 2:
Mailing Address - City:DUBACH
Mailing Address - State:LA
Mailing Address - Zip Code:71235-2681
Mailing Address - Country:US
Mailing Address - Phone:318-497-3372
Mailing Address - Fax:
Practice Address - Street 1:126 SENTEL LN
Practice Address - Street 2:
Practice Address - City:DUBACH
Practice Address - State:LA
Practice Address - Zip Code:71235-2681
Practice Address - Country:US
Practice Address - Phone:318-497-3372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health