Provider Demographics
NPI:1891069738
Name:ERRICO-DAVIS, MARIE LINDA
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:LINDA
Last Name:ERRICO-DAVIS
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 1:3813 CORBETT DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2707
Mailing Address - Country:US
Mailing Address - Phone:405-413-6336
Mailing Address - Fax:
Practice Address - Street 1:3813 CORBETT DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2707
Practice Address - Country:US
Practice Address - Phone:405-413-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health