Healthcare Provider Details

I. General information

NPI: 1114267416
Provider Name (Legal Business Name): ERICA ESQUEDA RIVERA LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2013
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9861 DYER ST STE 2
EL PASO TX
79924-4747
US

IV. Provider business mailing address

9861 DYER STREE SUITE 2
EL PASO TX
79924-4747
US

V. Phone/Fax

Practice location:
  • Phone: 915-202-5778
  • Fax: 915-271-8112
Mailing address:
  • Phone: 915-202-5778
  • Fax: 915-757-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12025
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68797
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: