Provider Demographics
NPI:1336578723
Name:BROWN, ERICA D (MA, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:MA, LAC, NCC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:D
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LMCHA, NCC
Mailing Address - Street 1:17372 W HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1736
Mailing Address - Country:US
Mailing Address - Phone:313-575-9629
Mailing Address - Fax:
Practice Address - Street 1:100 N HOWARD ST STE W
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0508
Practice Address - Country:US
Practice Address - Phone:623-273-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61498768101YM0800X
MI6401011925101YM0800X
AZLAC-18130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health