Provider Demographics
NPI:1750746384
Name:SAMPLE, ERICKA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ERICKA
Middle Name:
Last Name:SAMPLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36860 RED BERRY RD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-2347
Mailing Address - Country:US
Mailing Address - Phone:302-249-6481
Mailing Address - Fax:
Practice Address - Street 1:36860 RED BERRY RD
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-2347
Practice Address - Country:US
Practice Address - Phone:302-249-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00014201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical