Provider Demographics
NPI:1275349532
Name:MASON, ERMA J
Entity type:Individual
Prefix:
First Name:ERMA
Middle Name:J
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERMA
Other - Middle Name:J
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11129 HARRIS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28087-0102
Mailing Address - Country:US
Mailing Address - Phone:704-807-4249
Mailing Address - Fax:
Practice Address - Street 1:11129 HARRIS RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7775
Practice Address - Country:US
Practice Address - Phone:980-295-2603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP018906104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker