Provider Demographics
NPI:1649840851
Name:THOMPKINS, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:THOMPKINS
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 1:714 S 14TH AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-5520
Mailing Address - Country:US
Mailing Address - Phone:786-312-8978
Mailing Address - Fax:
Practice Address - Street 1:2500 HOLLYWOOD BLVD STE 410
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6615
Practice Address - Country:US
Practice Address - Phone:754-260-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW158491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical