Doctor Name: | ERICA G. LIGHTBODY |
NPI Number: | 1104254705 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 447326J |
Business Practice Address: | 516 176th St E Spanaway, WA - 983878335 |
Business Phone Number: | 2536838860 |
Business Fax Number: | |
Mailing Address: | 3110 32nd Avenue Ct Se, PUYALLUP |
State: | WA |
Postal Code: | 983742090 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/17/2013 |
NPI Last Update Date: | 10/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 447326J |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |