Provider Demographics
NPI:1124323548
Name:MARTIN, ERICA LUDEALY
Entity type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:LUDEALY
Last Name:MARTIN
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 1:7348 MILTON AVE
Mailing Address - Street 2:APT #14
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1556
Mailing Address - Country:US
Mailing Address - Phone:310-995-6251
Mailing Address - Fax:
Practice Address - Street 1:7348 MILTON AVE
Practice Address - Street 2:APT #14
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1556
Practice Address - Country:US
Practice Address - Phone:310-995-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist