Basic Information
| Provider Information | |||||||||
| NPI: | 1033586409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAN SKIKE | ||||||||
| FirstName: | ERICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1885 LUNDY AVE STE 223 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951311888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082849000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2015 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | ACSW104119 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | ZZZ91892Z | 01 | CA | SANTA CRUZ COUNTY MEDICARE GROUP PTAN# | OTHER |