Provider Demographics
NPI:1770979379
Name:MATZDORFF, ERIKA DEL CARMEN (LPCA)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:DEL CARMEN
Last Name:MATZDORFF
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1441
Mailing Address - Country:US
Mailing Address - Phone:270-312-5090
Mailing Address - Fax:
Practice Address - Street 1:202 N MULBERRY ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1441
Practice Address - Country:US
Practice Address - Phone:270-312-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCCCA00218253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional