Provider Demographics
NPI:1770602195
Name:WATERFORD, ERICA N (BA)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:N
Last Name:WATERFORD
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 GATEWAY OAKS DR APT 121
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-4219
Mailing Address - Country:US
Mailing Address - Phone:530-902-2896
Mailing Address - Fax:
Practice Address - Street 1:2100 5TH ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6591
Practice Address - Country:US
Practice Address - Phone:530-753-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health