Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor | #75132117 | WA |
N | 101YP2500X | Professional Counselor | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TC1900X | Counseling Psychologist | ||
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TF0000X | Family Psychologist | ||
N | 103TF0200X | Forensic Psychologist | ||
N | 103TH0100X | Health Service | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 103TP0814X | Psychoanalysis | ||
N | 103TP2701X | Group Psychotherapist | ||
N | 103TS0200X | School Psychologist |
NPI | 1114323367 |
---|---|
Provider Name | Phyllis Ericson-Davis |
First Address | Greenville, SC 29617-7901 |
Second Address | Greenville, SC 29617-7901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2014 |
Last Update Date | 19/11/2014 |