Healthcare Provider Details

I. General information

NPI: 1659289882
Provider Name (Legal Business Name): ERICA COLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7319 MARTIN ST STE 3
GLOUCESTER VA
23061-5358
US

IV. Provider business mailing address

7319 MARTIN ST STE 3
GLOUCESTER VA
23061-5358
US

V. Phone/Fax

Practice location:
  • Phone: 804-669-3190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906017895
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: