Provider Demographics
NPI:1194219618
Name:WARD, ERIC RUSSELL (MA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RUSSELL
Last Name:WARD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 LOCH HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-7041
Mailing Address - Country:US
Mailing Address - Phone:757-256-9683
Mailing Address - Fax:
Practice Address - Street 1:333 KELLAM RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2746
Practice Address - Country:US
Practice Address - Phone:757-256-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist