Healthcare Provider Details

I. General information

NPI: 1083247514
Provider Name (Legal Business Name): ERICA FRANCES VEST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHURCH AVE SW UNIT 2831
ROANOKE VA
24001-3008
US

IV. Provider business mailing address

536 W VISTA WAY STE A
VISTA CA
92083-5704
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: