Provider Demographics
NPI:1831733625
Name:PENN, ERICA (LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:PENN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 CEDAR CREEK GRADE STE 203
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6460
Mailing Address - Country:US
Mailing Address - Phone:540-450-2735
Mailing Address - Fax:
Practice Address - Street 1:817 CEDAR CREEK GRADE STE 203
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6460
Practice Address - Country:US
Practice Address - Phone:540-450-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional