Provider Demographics
NPI:1700143286
Name:WILSON, ERICA ROBIN (PH D, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ROBIN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PH D, BCBA-D
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:HOLDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 NW 58TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-1004
Mailing Address - Country:US
Mailing Address - Phone:949-525-5659
Mailing Address - Fax:
Practice Address - Street 1:332 NW 58TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-1004
Practice Address - Country:US
Practice Address - Phone:949-525-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-01-0418103K00000X
OR10183544103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-01-0418OtherBCBA
OR10183544OtherLICENSED BEHAVIOR ANALYST