Provider Demographics
NPI:1174116610
Name:JENNIFER ERICKSON COACHING, LLC
Entity type:Organization
Organization Name:JENNIFER ERICKSON COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHOLOGIST, LIFE COACH
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-690-2537
Mailing Address - Street 1:10712 PROVIDENCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7488
Mailing Address - Country:US
Mailing Address - Phone:804-690-2537
Mailing Address - Fax:
Practice Address - Street 1:4235 INNSLAKE DR STE 210
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5505
Practice Address - Country:US
Practice Address - Phone:804-690-2537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Single Specialty