Provider Demographics
NPI:1194181743
Name:THOMPSON, ERICA FELISA (LCSW, MSW, MBA)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:FELISA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW, MSW, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7218 MISTY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2709
Mailing Address - Country:US
Mailing Address - Phone:210-992-9367
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:JBSA FT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:726-228-0296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2024-09-20
Deactivation Date:2020-08-14
Deactivation Code:
Reactivation Date:2020-08-28
Provider Licenses
StateLicense IDTaxonomies
TX623451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62345OtherCLKINICAL SOCIAL WORK LICENSE
14949119OtherCAQH