Provider Demographics
NPI:1063880797
Name:GAVIDIA, ERICA (LCSW, PPSC)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:GAVIDIA
Suffix:
Gender:F
Credentials:LCSW, PPSC
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:NOVOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, PPSC
Mailing Address - Street 1:PO BOX 15392
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:127 ARDEN WAY UNIT A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-2919
Practice Address - Country:US
Practice Address - Phone:213-674-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW89594104100000X
CAASW71663104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker