Provider Demographics
NPI:1538848767
Name:CAGLE, ERICA PATRICE (LCAS-A)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:PATRICE
Last Name:CAGLE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 WILMA AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-7538
Mailing Address - Country:US
Mailing Address - Phone:336-778-6239
Mailing Address - Fax:
Practice Address - Street 1:2290 PREMIER PARK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-6306
Practice Address - Country:US
Practice Address - Phone:336-893-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25451101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)