Provider Demographics
NPI:1043607286
Name:FORMWAY, ERICA CARMAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:CARMAN
Last Name:FORMWAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MENDOCINO AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4860
Mailing Address - Country:US
Mailing Address - Phone:707-595-0244
Mailing Address - Fax:
Practice Address - Street 1:920 MENDOCINO AVE STE 8
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4860
Practice Address - Country:US
Practice Address - Phone:707-595-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist