Healthcare Provider Details

I. General information

NPI: 1194142943
Provider Name (Legal Business Name): ERIC KID QUICK LPC, LAC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 FOREST HILL BLVD STE E
LAKE CLARKE SHORES FL
33406-6052
US

IV. Provider business mailing address

1497 FOREST HILL BLVD STE E
LAKE CLARKE SHORES FL
33406-6052
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-5687
  • Fax: 561-433-5705
Mailing address:
  • Phone: 561-433-5687
  • Fax: 561-433-5705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number175
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6484
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: