Provider Demographics
NPI:1982183448
Name:EKERSON, ERICA GAGE
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:GAGE
Last Name:EKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 E WISHKAH
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:VA
Mailing Address - Zip Code:98550
Mailing Address - Country:US
Mailing Address - Phone:360-819-3007
Mailing Address - Fax:360-532-0577
Practice Address - Street 1:244 E WISHKAH
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:VA
Practice Address - Zip Code:98550
Practice Address - Country:US
Practice Address - Phone:360-819-3007
Practice Address - Fax:360-532-0577
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAEEKERSONMedicaid