Maurice Shane Etter, LCSW, CSAC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

0904009951 Issued in VA

Practice address

504 23Rd St NW
Roanoke, VA 24017-5414

Phone

(540) 345-2606

Fax

(540) 345-2608

NPI assigned

Oct 6, 2017

Last updated

Jun 23, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CCCS & Associates LLC

  • Professional Counselor
  • Virginia Beach, VA
  • NPI 1124542949

  Clinical

  Medicare reassignment NPD
• Crescent Counseling & Casework Services Inc.

  • Community/Behavioral Health Agency
  • Virginia Beach, VA
  • NPI 1790095081
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1053821884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2328 PETERS CREEK RD NW STE 102",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240171621",
            "telephone_number": "540-345-2606",
            "fax_number": "540-345-2608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 23RD ST NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240175414",
            "telephone_number": "540-345-2606",
            "fax_number": "540-345-2608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTER",
        "first_name": "MAURICE",
        "middle_name": "SHANE",
        "credential": "LCSW, CSAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-06",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "1053821884",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904009951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Essis
• Sarah M Ethridge, LCSW
• Etter Enterprises Inc
• Diane N Etter, OPTICIAN
• Ericka Brooke Etter, LCSW
• Betty C Etzler, LCSW
• Erica Eubank
• Taylor L Eubank, OTR/L
• Emily Ann Evans-Hoeker, M.D.
• Ashley Evans, PT, DPT

• Clinical Social Worker in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Clinical Social Worker in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.