Provider Demographics
NPI:1760164842
Name:WOODALL, ERICA (LCSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 BROADMOOR LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2705
Mailing Address - Country:US
Mailing Address - Phone:940-331-0505
Mailing Address - Fax:469-645-2028
Practice Address - Street 1:3020 BROADMOOR LN STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2705
Practice Address - Country:US
Practice Address - Phone:940-331-0505
Practice Address - Fax:469-645-2028
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX627891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical