Provider Demographics
NPI:1972830453
Name:GAUDREAULT, ERIN E (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:E
Last Name:GAUDREAULT
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PINEWILD DR
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9735
Mailing Address - Country:US
Mailing Address - Phone:540-729-7097
Mailing Address - Fax:
Practice Address - Street 1:150 W. VERMONT AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-4823
Practice Address - Country:US
Practice Address - Phone:540-729-7097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0115011041C0700X
VA09040071291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical