Individual
ERICA ISHMAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
621 W MADRONE ST, ROSEBURG, OR 97470-3090
(541) 492-0241
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
(541) 492-0190
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
C5186
OR
Other
Enumeration date
01/07/2016
Last updated
03/19/2019
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