MEDICARE: ERICKA G JARVIS M.S., LCMHCA

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
1	101YM0800X	Mental Health Counselor	A20501	NC

General Provider Information

NPI Number	:	1669904009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICKA G JARVIS M.S., LCMHCA

Provider Business Mailing Address
First Line	:	4412 PARK RD STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4412 PARK RD STE B
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3130
Country	:	US
Telephone Number	:	631-416-1319
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	12/11/2024

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