Provider Demographics
NPI:1871702647
Name:ROPER-ERICSON, KATHIE IRENE (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHIE
Middle Name:IRENE
Last Name:ROPER-ERICSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 BANGOR CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4507
Mailing Address - Country:US
Mailing Address - Phone:256-500-4187
Mailing Address - Fax:256-234-7517
Practice Address - Street 1:500 LEE ST.
Practice Address - Street 2:THE GREENHOUSE
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35011
Practice Address - Country:US
Practice Address - Phone:256-500-4187
Practice Address - Fax:256-234-7517
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional