Provider Demographics
NPI:1861266504
Name:ERIKSSON, MARINELA (MA)
Entity type:Individual
Prefix:
First Name:MARINELA
Middle Name:
Last Name:ERIKSSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 HAREWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3751
Mailing Address - Country:US
Mailing Address - Phone:828-302-9748
Mailing Address - Fax:
Practice Address - Street 1:6406 CARMEL RD STE 308
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8267
Practice Address - Country:US
Practice Address - Phone:828-302-9748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist