Healthcare Provider Details

I. General information

NPI: 1497101620
Provider Name (Legal Business Name): JENNIFER ERICKSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10712 PROVIDENCE PARK DR
ASHLAND VA
23005-7488
US

IV. Provider business mailing address

10712 PROVIDENCE PARK DR
ASHLAND VA
23005-7488
US

V. Phone/Fax

Practice location:
  • Phone: 804-690-2537
  • Fax:
Mailing address:
  • Phone: 804-690-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH19973
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12884764-6004
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007469
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-24106
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701007469
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2671367
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: