Provider Demographics
NPI:1841385150
Name:ERICKSON, JAMES ALBERT (MFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALBERT
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 E MAIN ST
Mailing Address - Street 2:STE 811
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2905
Mailing Address - Country:US
Mailing Address - Phone:925-366-3644
Mailing Address - Fax:
Practice Address - Street 1:343 E MAIN ST
Practice Address - Street 2:SUITE 811
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2905
Practice Address - Country:US
Practice Address - Phone:209-366-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT23915106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist