Provider Demographics
NPI:1548503428
Name:GREGORY, ERICA ANN (LMFT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 N POINT PKWY STE 280
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1176
Mailing Address - Country:US
Mailing Address - Phone:404-834-2363
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 280
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1176
Practice Address - Country:US
Practice Address - Phone:404-834-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMFT001278OtherLICENSE