Provider Demographics
NPI:1124855853
Name:MCDADE, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MCDADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 W BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5842
Mailing Address - Country:US
Mailing Address - Phone:804-728-0088
Mailing Address - Fax:
Practice Address - Street 1:9039 W BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-5842
Practice Address - Country:US
Practice Address - Phone:804-728-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0734011931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty