Provider Demographics
NPI:1013215441
Name:THEODORIDES, ERIKA GIOIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:GIOIA
Last Name:THEODORIDES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 JEFFERSON ST.
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504
Mailing Address - Country:US
Mailing Address - Phone:617-379-0496
Mailing Address - Fax:617-807-0958
Practice Address - Street 1:1000 JEFFERSON ST.
Practice Address - Street 2:SUITE 2C
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504
Practice Address - Country:US
Practice Address - Phone:617-379-0496
Practice Address - Fax:617-807-0958
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004972101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1871542340Medicaid