Provider Demographics
NPI:1386959708
Name:ALLEN, ERICA M (PCC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:M
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PCC
Mailing Address - Street 1:25111 COUNTRY CLUB BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5345
Mailing Address - Country:US
Mailing Address - Phone:216-831-6611
Mailing Address - Fax:440-614-2526
Practice Address - Street 1:25111 COUNTRY CLUB BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5345
Practice Address - Country:US
Practice Address - Phone:216-831-6611
Practice Address - Fax:440-614-2526
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0700430101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341458441Medicaid