Provider Demographics
NPI:1336689744
Name:MCCOMAS-CHURCH, ERICKA STARR (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERICKA
Middle Name:STARR
Last Name:MCCOMAS-CHURCH
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 1:855 LOVERS LN STE 107
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7989
Mailing Address - Country:US
Mailing Address - Phone:270-599-4004
Mailing Address - Fax:
Practice Address - Street 1:855 LOVERS LN STE 107
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7989
Practice Address - Country:US
Practice Address - Phone:270-599-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2524551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical