Healthcare Provider Details

I. General information

NPI: 1760761373
Provider Name (Legal Business Name): ERIN WHITAKER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SE 4TH AVE STE 107
DELRAY BEACH FL
33483-4574
US

IV. Provider business mailing address

85 SE 4TH AVE STE 107
DELRAY BEACH FL
33483-4574
US

V. Phone/Fax

Practice location:
  • Phone: 561-995-7388
  • Fax:
Mailing address:
  • Phone: 561-995-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: