Provider Demographics
NPI:1366946626
Name:THACKER, ERICA LA'SHAE (BA, T-CADC, TCM)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LA'SHAE
Last Name:THACKER
Suffix:
Gender:F
Credentials:BA, T-CADC, TCM
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LA'SHAE
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, T-CADC, TCM
Mailing Address - Street 1:255 CHURCH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3499
Mailing Address - Country:US
Mailing Address - Phone:606-432-5660
Mailing Address - Fax:606-432-2738
Practice Address - Street 1:255 CHURCH ST STE 100
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3499
Practice Address - Country:US
Practice Address - Phone:606-432-5660
Practice Address - Fax:606-432-2738
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health