Provider Demographics
NPI:1255716239
Name:SCANNELL, ERICA MICHELLE (LICSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MICHELLE
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MICHELLE
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 MOSSY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7878
Mailing Address - Country:US
Mailing Address - Phone:540-290-9405
Mailing Address - Fax:
Practice Address - Street 1:21 E WHEELWRIGHT ST
Practice Address - Street 2:
Practice Address - City:ALLYN
Practice Address - State:WA
Practice Address - Zip Code:98524-7787
Practice Address - Country:US
Practice Address - Phone:717-500-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0089811041C0700X
SC147021041C0700X
PACW0241981041C0700X
WALW609703391041C0700X
PASW132408104100000X
CT0140321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2204889Medicaid