Provider Demographics
NPI:1982467783
Name:BROWN, ERICA SHELLIAN
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:SHELLIAN
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 E LIME ST APT 8
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5479
Mailing Address - Country:US
Mailing Address - Phone:863-838-6344
Mailing Address - Fax:
Practice Address - Street 1:150 3RD ST SW STE 109
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2980
Practice Address - Country:US
Practice Address - Phone:863-271-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-24-14981103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst