Healthcare Provider Details

I. General information

NPI: 1780221820
Provider Name (Legal Business Name): ERICA M JOY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA JOY HICKEY

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 3RD AVE
LONGMONT CO
80501-5926
US

IV. Provider business mailing address

PO BOX 605
NEHALEM OR
97131-0600
US

V. Phone/Fax

Practice location:
  • Phone: 720-310-5306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0019098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: