Healthcare Provider Details

I. General information

NPI: 1134424112
Provider Name (Legal Business Name): ERIKA RENEE ETCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIKA RENEE HOLZWARTH

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 SKYWAY
PARADISE CA
95969
US

IV. Provider business mailing address

7200 SKYWAY
PARADISE CA
95969
US

V. Phone/Fax

Practice location:
  • Phone: 530-877-6764
  • Fax: 530-894-5791
Mailing address:
  • Phone: 530-877-6764
  • Fax: 530-894-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: