MEDICARE: ERICA WOODALL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	62789	TX

General Provider Information

NPI Number	:	1760164842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA WOODALL LCSW

Provider Business Mailing Address
First Line	:	3020 BROADMOOR LN STE 200
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2705
Country	:	US
Telephone Number	:	940-331-0505
Fax Number	:	469-645-2028

Provider Business Practice Location Address
First Line	:	3020 BROADMOOR LN STE 200
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-2705
Country	:	US
Telephone Number	:	940-331-0505
Fax Number	:	469-645-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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