| NPI | 1124663695 |
|---|---|
| Former Name | ERICKA MICHELLE TIDMORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME XL6874) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC7487) |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2023-10-12 |