Provider Demographics
NPI:1144904723
Name:PRINDLE, ERICA DANIELLE
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:DANIELLE
Last Name:PRINDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SEQUOIA
Other - Middle Name:
Other - Last Name:PRINDLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-1579
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1579
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95061-1579
Practice Address - Country:US
Practice Address - Phone:415-498-1325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1009131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical