Provider Demographics
NPI:1053605204
Name:BLEY, ERICA B (LCPC)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:B
Last Name:BLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:L
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, NCC
Mailing Address - Street 1:14307 DAIRYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9633
Mailing Address - Country:US
Mailing Address - Phone:443-797-7710
Mailing Address - Fax:
Practice Address - Street 1:121 E RIDGELY RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5222
Practice Address - Country:US
Practice Address - Phone:443-809-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3828101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool