Healthcare Provider Details

I. General information

NPI: 1043519572
Provider Name (Legal Business Name): ERICA LOWERY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 EL CAJON BLVD #210
SAN DIEGO CA
92115-4450
US

IV. Provider business mailing address

2125 REED AVE APT. 205
SAN DIEGO CA
92109-5546
US

V. Phone/Fax

Practice location:
  • Phone: 619-640-3266
  • Fax:
Mailing address:
  • Phone: 702-686-5076
  • Fax:

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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: