Provider Demographics
NPI:1730949603
Name:ETTER, ERICKA BROOKE (LCSW)
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:BROOKE
Last Name:ETTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6782 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5021
Mailing Address - Country:US
Mailing Address - Phone:540-529-9489
Mailing Address - Fax:
Practice Address - Street 1:808 5TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-3930
Practice Address - Country:US
Practice Address - Phone:540-529-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040161371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical