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General NPI Number Information
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NPI Number | 1023557170
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Entity Type | Individual
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Provider Name | ERICNIESHA TAYLOR LCSW-C, LICSW
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Gender | Female
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 1100 WILFORD HALL LOOP BLDG. 4554, 59 MDW/GME
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-5972
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WILFORD HALL LOOP BLDG. 4554, 59 MDW/GME
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City | JBSA LACKLAND
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State | TX
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Zip | 78236-9908
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Country | US
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Telephone | 210-292-5972
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 21703
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SC60721786
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | LW61040860
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License Number State | WA
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