Provider Demographics
NPI:1285087742
Name:CHARLES, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:CHARLES
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 1:4090 HODGES BLVD
Mailing Address - Street 2:APT 814
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-4204
Mailing Address - Country:US
Mailing Address - Phone:678-358-2545
Mailing Address - Fax:
Practice Address - Street 1:4090 HODGES BLVD
Practice Address - Street 2:APT 814
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-4204
Practice Address - Country:US
Practice Address - Phone:678-358-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other