Provider Demographics
NPI:1730308172
Name:FREDRICKSON, ERLING L (LISW-CP)
Entity Type:Individual
Prefix:
First Name:ERLING
Middle Name:L
Last Name:FREDRICKSON
Suffix:
Gender:M
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-0098
Mailing Address - Country:US
Mailing Address - Phone:828-898-6140
Mailing Address - Fax:828-898-8513
Practice Address - Street 1:158 GRANDFATHER HOME WAY, HICKORY NUT GAP RD.
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604
Practice Address - Country:US
Practice Address - Phone:828-898-6140
Practice Address - Fax:828-898-8513
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57101041C0700X
NCC0062941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical