Provider Demographics
NPI:1972278141
Name:YOUNGBLOOD, ERICA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 OLYMPIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1342
Mailing Address - Country:US
Mailing Address - Phone:909-627-2786
Mailing Address - Fax:
Practice Address - Street 1:2397 OLYMPIC VIEW DR
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1342
Practice Address - Country:US
Practice Address - Phone:909-627-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA912542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer