Provider Demographics
NPI:1639062474
Name:DENSMORE, ERICA LEEANN
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LEEANN
Last Name:DENSMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LEEANN
Other - Last Name:POPPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1772 MALLARD RD
Mailing Address - Street 2:
Mailing Address - City:ODUM
Mailing Address - State:GA
Mailing Address - Zip Code:31555-8401
Mailing Address - Country:US
Mailing Address - Phone:912-222-1586
Mailing Address - Fax:
Practice Address - Street 1:997 LEVI H KENNEDY RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-5436
Practice Address - Country:US
Practice Address - Phone:912-222-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-425465106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician