Provider Demographics
NPI:1023433125
Name:TAGGE, ERIN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:TAGGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 KNIGHT VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:STOKESDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27357-9280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 KIMEL PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6951
Practice Address - Country:US
Practice Address - Phone:336-718-3550
Practice Address - Fax:336-277-6981
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10230101YM0800X
NCA10230101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor