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General NPI Number Information
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NPI Number | 1154573053
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Entity Type | Individual
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Provider Name | DAVID ERLICH LCSW & LISAC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 413 E FLORENCE BLVD
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City | CASA GRANDE
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State | AZ
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Zip | 85122-4112
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Country | US
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Telephone | 520-876-5764
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Fax | 520-876-5613
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Provider Business Mailing Address
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Address Line | 413 E FLORENCE BLVD
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City | CASA GRANDE
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State | AZ
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Zip | 85122-4112
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Country | US
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Telephone | 520-876-5764
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Fax | 520-876-5613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 11736
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12071
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License Number State | AZ
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