Provider Demographics
NPI:1396051710
Name:MORA, ERIKA VANNESA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:VANNESA
Last Name:MORA
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:VANNESA
Other - Last Name:ALEJANDRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LSWAA, LICSW
Mailing Address - Street 1:500 SE EVERETT MALL WAY STE B202
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-8122
Mailing Address - Country:US
Mailing Address - Phone:425-953-3910
Mailing Address - Fax:
Practice Address - Street 1:500 SE EVERETT MALL WAY STE B202
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-8122
Practice Address - Country:US
Practice Address - Phone:425-953-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60860628104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical