Healthcare Provider Details

I. General information

NPI: 1619935897
Provider Name (Legal Business Name): RAY ERICKSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W EL CAMINO AVE
SACRAMENTO CA
95833-2245
US

IV. Provider business mailing address

2830 I ST SUITE 301
SACRAMENTO CA
95816-4311
US

V. Phone/Fax

Practice location:
  • Phone: 916-333-4169
  • Fax: 916-333-4169
Mailing address:
  • Phone: 916-333-4169
  • Fax: 916-333-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCS15810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: