Healthcare Provider Details

I. General information

NPI: 1821908682
Provider Name (Legal Business Name): ERICA DECORDOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 WESTLAKE RD STE 202
FAYETTEVILLE NC
28314-4866
US

IV. Provider business mailing address

245 WESTLAKE RD STE 202
FAYETTEVILLE NC
28314-4866
US

V. Phone/Fax

Practice location:
  • Phone: 910-753-4865
  • Fax: 910-722-1549
Mailing address:
  • Phone: 910-753-4865
  • Fax: 910-722-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-32102
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: