Individual
MR. MARK ERIC ERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
650 E INDIAN SCHOOL RD, MHICM, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
650 E INDIAN SCHOOL RD, MHICM, PHOENIX, AZ 85012-1839
(602) 277-5551
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2002020181
MO
Other
Enumeration date
06/10/2006
Last updated
07/08/2007
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