Provider Demographics
NPI:1659617421
Name:EKEROMA, FAIILETASI VS (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:FAIILETASI
Middle Name:VS
Last Name:EKEROMA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:SCARLETT
Other - Middle Name:
Other - Last Name:EKEROMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:700 SLEATER KINNEY RD SE
Mailing Address - Street 2:SUITE B #185
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6746
Mailing Address - Country:US
Mailing Address - Phone:253-256-5149
Mailing Address - Fax:
Practice Address - Street 1:1305 BARNARD ST # 202
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6746
Practice Address - Country:US
Practice Address - Phone:253-256-5149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LF60788399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist