Provider Demographics
NPI:1326395187
Name:WOOTEN, ERICA NICOLE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:NICOLE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 CREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2050
Mailing Address - Country:US
Mailing Address - Phone:813-841-8715
Mailing Address - Fax:
Practice Address - Street 1:11608 CREST CREEK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2050
Practice Address - Country:US
Practice Address - Phone:813-841-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW7171104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker