Provider Demographics
NPI:1124709704
Name:COREY, ERICA LEEANN (LGP14106)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEEANN
Last Name:COREY
Suffix:
Gender:F
Credentials:LGP14106
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 S DIVISION ST UNIT 401
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6921
Mailing Address - Country:US
Mailing Address - Phone:443-859-8584
Mailing Address - Fax:
Practice Address - Street 1:1342 S DIVISION ST UNIT 401
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6921
Practice Address - Country:US
Practice Address - Phone:443-859-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP14106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health