Healthcare Provider Details

I. General information

NPI: 1316201411
Provider Name (Legal Business Name): ERICA D'ANNA ERVIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 SPENCER MOUNTAIN RD
GASTONIA NC
28054-3045
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-836-9608
  • Fax:
Mailing address:
  • Phone: 704-730-7003
  • Fax: 704-865-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP006962
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: