Healthcare Provider Details

I. General information

NPI: 1124740642
Provider Name (Legal Business Name): JOSIAH ERICKSON LCSW, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 300
VANCOUVER WA
98683-5509
US

V. Phone/Fax

Practice location:
  • Phone: 360-619-2226
  • Fax: 360-326-9691
Mailing address:
  • Phone: 360-619-2226
  • Fax: 360-326-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1124740642
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL17404
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWI.LW.70077575
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: