Healthcare Provider Details

I. General information

NPI: 1043662836
Provider Name (Legal Business Name): ERICKA STUCKEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GRANTS FERRY RD
BRANDON MS
39047-9023
US

IV. Provider business mailing address

622 RIVERSIDE DR
MONROE LA
71201-6211
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 318-398-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14388
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: