Provider Demographics
NPI:1568963502
Name:WHITNEY, ERICA (LSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:KOLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:712 LEADERSHIP CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1409
Mailing Address - Country:US
Mailing Address - Phone:732-824-3595
Mailing Address - Fax:
Practice Address - Street 1:425 JACK MARTIN BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7732
Practice Address - Country:US
Practice Address - Phone:732-836-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06131500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health