Provider Demographics
NPI:1144059635
Name:WITHAM, ERICKA (LCPC)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:WITHAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CROOKED RD
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-7416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 CHURCH LN STE 1
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:ME
Practice Address - Zip Code:04640-3128
Practice Address - Country:US
Practice Address - Phone:207-814-8945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7221101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional