Provider Demographics
NPI:1699803171
Name:ERICKSEN, ROSAN (CADC II)
Entity type:Individual
Prefix:MS
First Name:ROSAN
Middle Name:
Last Name:ERICKSEN
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DONNA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92583-5517
Mailing Address - Country:US
Mailing Address - Phone:951-487-9627
Mailing Address - Fax:951-487-2448
Practice Address - Street 1:607 DONNA WAY
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5517
Practice Address - Country:US
Practice Address - Phone:951-487-9627
Practice Address - Fax:951-487-2448
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA835700101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)