Provider Demographics
NPI:1922283423
Name:SINGLETON, ERICA LAQUONIA (RN)
Entity Type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LAQUONIA
Last Name:SINGLETON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:JAROME
Other - Last Name:JACKSON
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2350 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-8127
Mailing Address - Country:US
Mailing Address - Phone:662-332-7820
Mailing Address - Fax:662-332-7022
Practice Address - Street 1:1654 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-7108
Practice Address - Country:US
Practice Address - Phone:662-332-7022
Practice Address - Fax:662-332-7022
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07186736251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services