Provider Demographics
NPI:1326742974
Name:BLOODWORTH, ERIKA (LCMHC)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:
Last Name:BLOODWORTH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 WILKINS RD
Mailing Address - Street 2:
Mailing Address - City:ROUGEMONT
Mailing Address - State:NC
Mailing Address - Zip Code:27572-9478
Mailing Address - Country:US
Mailing Address - Phone:919-724-7929
Mailing Address - Fax:
Practice Address - Street 1:1200 BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3576
Practice Address - Country:US
Practice Address - Phone:984-777-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health