Healthcare Provider Details

I. General information

NPI: 1477541928
Provider Name (Legal Business Name): CAROLYN ERICKSON LPC C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 TRINITY DR STE C
LOS ALAMOS NM
87544-2226
US

IV. Provider business mailing address

3250 TRINITY DR STE C
LOS ALAMOS NM
87544-2226
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-1419
  • Fax: 505-661-0055
Mailing address:
  • Phone: 505-662-1419
  • Fax: 505-661-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0073101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: