Provider Demographics
NPI:1104327394
Name:MARUT, ERICA LACEY (LPC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LACEY
Last Name:MARUT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:
Other - Last Name:MARUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:817 CEDAR CREEK GRADE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6460
Mailing Address - Country:US
Mailing Address - Phone:540-631-5563
Mailing Address - Fax:
Practice Address - Street 1:817 CEDAR CREEK GRADE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6460
Practice Address - Country:US
Practice Address - Phone:540-631-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE