Provider Demographics
NPI:1093539355
Name:ROCHE DIKE, ERICA DENISE (RBT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DENISE
Last Name:ROCHE DIKE
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 PANTHERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1248
Mailing Address - Country:US
Mailing Address - Phone:608-577-2404
Mailing Address - Fax:
Practice Address - Street 1:3877 PANTHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1248
Practice Address - Country:US
Practice Address - Phone:608-577-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1117814106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician