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NPI Code Detail

MEDICARE: ERICA MANNING SUDPT

MEDICARE: ERICA MANNING SUDPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCO60901921WA

General Provider Information

NPI Number : 1255920757
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA MANNING SUDPT
Provider Business Mailing Address
First Line : 288 SW JUDSON DR
Second Line :
City : OAK HARBOR
State : WA
Zip : 98277-5800
Country : US
Telephone Number : 850-382-0947
Fax Number :
Provider Business Practice Location Address
First Line : 1905 CONTINENTAL PL
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-5633
Country : US
Telephone Number : 360-755-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2021
Last Update Date : 01/11/2021

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