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General NPI Number Information
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NPI Number | 1629775846
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Entity Type | Individual
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Provider Name | ERICA D GORE
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Gender | Female
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 1533 DUXBERRY AVE
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City | COLUMBUS
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State | OH
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Zip | 43211-1619
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Country | US
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Telephone | 614-357-1937
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 DUXBERRY AVE
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City | COLUMBUS
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State | OH
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Zip | 43211-1619
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Country | US
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Telephone | 614-357-1937
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Fax |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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Taxonomy #3
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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Taxonomy #4
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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