Provider Demographics
NPI:1790276954
Name:EDGE, ERICA RENEE (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:RENEE
Last Name:EDGE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:RENEE
Other - Last Name:ACOTANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4007 LONG POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-5348
Mailing Address - Country:US
Mailing Address - Phone:808-825-1650
Mailing Address - Fax:
Practice Address - Street 1:4007 LONG POINT BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-5348
Practice Address - Country:US
Practice Address - Phone:808-825-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009454841041C0700X
HI43161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical