Provider Demographics
NPI:1760962146
Name:GUICE, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:GUICE
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 1:1611 PATRIOT PKWY APT C
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-1253
Mailing Address - Country:US
Mailing Address - Phone:850-376-5988
Mailing Address - Fax:
Practice Address - Street 1:1875 N BELMONT AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-8897
Practice Address - Country:US
Practice Address - Phone:907-406-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty