Healthcare Provider Details

I. General information

NPI: 1053143891
Provider Name (Legal Business Name): ERIN R CHOICE MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 IRON BRIDGE RD STE 100
CHESTER VA
23831-1669
US

IV. Provider business mailing address

7413 EXWICK LN
NORTH CHESTERFIELD VA
23237-1835
US

V. Phone/Fax

Practice location:
  • Phone: 804-404-3403
  • Fax: 804-895-7868
Mailing address:
  • Phone: 804-617-7838
  • Fax: 804-895-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014229
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701013894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: