Provider Demographics
NPI:1174951941
Name:ERKENBRACK, KELLY (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:ERKENBRACK
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:106 MALLARD CV
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8372
Mailing Address - Country:US
Mailing Address - Phone:603-986-4623
Mailing Address - Fax:
Practice Address - Street 1:106 MALLARD CV
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-8372
Practice Address - Country:US
Practice Address - Phone:603-986-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0106351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical