Provider Demographics
NPI:1093529067
Name:SMALLA, ERICA LYNN (BA,QP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:SMALLA
Suffix:
Gender:F
Credentials:BA,QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 HAVENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-6800
Mailing Address - Country:US
Mailing Address - Phone:616-856-9464
Mailing Address - Fax:
Practice Address - Street 1:157 HAVENBROOK DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-6800
Practice Address - Country:US
Practice Address - Phone:616-856-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-01
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical