Provider Demographics
NPI:1184408908
Name:TILLETT, ERICA G
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:G
Last Name:TILLETT
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 1:42455 10TH ST W STE 103
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7060
Mailing Address - Country:US
Mailing Address - Phone:213-665-6281
Mailing Address - Fax:
Practice Address - Street 1:42455 10TH ST W STE 103
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7060
Practice Address - Country:US
Practice Address - Phone:213-655-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1141661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical