Individual
ERICA GERALDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MDIV, LPC, NCC
Contact information
Practice address
4190 PEACE ROSE PL, LOGANVILLE, GA 30052-5112
(678) 640-3196
Mailing address
4190 PEACE ROSE PL, LOGANVILLE, GA 30052-5112
(678) 640-3196
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC011071
GA
101YP2500X
Professional Counselor
178.012703
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1673042
BLUE CROSS BLUE SHIELD
IL
05
—
2A00-IPI-178
—
IL
Enumeration date
04/13/2017
Last updated
11/26/2019
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