Provider Demographics
NPI:1801665765
Name:ERAZO, ANTONIA (MSW, LCSWA)
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:ERAZO
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 PLEASANT GARDEN RD APT 1D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-4666
Mailing Address - Country:US
Mailing Address - Phone:336-908-6559
Mailing Address - Fax:
Practice Address - Street 1:1146 NC HIGHWAY 86 N
Practice Address - Street 2:
Practice Address - City:YANCEYVILLE
Practice Address - State:NC
Practice Address - Zip Code:27379-8646
Practice Address - Country:US
Practice Address - Phone:336-694-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP01093371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical