Provider Demographics
NPI:1316671928
Name:SWEATT, ERICA LYNN KELLY
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN KELLY
Last Name:SWEATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 LA BONNE DR
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-8809
Mailing Address - Country:US
Mailing Address - Phone:251-210-2392
Mailing Address - Fax:
Practice Address - Street 1:104 LA BONNE DR
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-8809
Practice Address - Country:US
Practice Address - Phone:251-210-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001933106H00000X
ALL252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty