Provider Demographics
NPI:1205158136
Name:TIDD, ERICA LEIGH (LMHC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:TIDD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEIGH
Other - Last Name:PETTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:64 INDUSTRIAL PARK RD.
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-830-1630
Mailing Address - Fax:508-830-0768
Practice Address - Street 1:64 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-830-1630
Practice Address - Fax:508-830-0768
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA8850101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health