Provider Demographics
NPI:1205419348
Name:MARTIN, ERICA (LCSWA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:1100 CANE CREEK DRIVE
Mailing Address - Street 2:1100 CANE CREEK DRIVE
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-279-1436
Mailing Address - Fax:
Practice Address - Street 1:1100 CANE CREEK DRIVE
Practice Address - Street 2:1100 CANE CREEK DRIVE
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529
Practice Address - Country:US
Practice Address - Phone:919-279-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0161171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical