Provider Demographics
NPI:1639977440
Name:GREEN, ERICKA
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:ERICKA
Other - Middle Name:
Other - Last Name:BROOKSHIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4130 LINDEN AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3049
Mailing Address - Country:US
Mailing Address - Phone:937-716-1791
Mailing Address - Fax:
Practice Address - Street 1:4130 LINDEN AVE STE 245
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3049
Practice Address - Country:US
Practice Address - Phone:937-716-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator