Healthcare Provider Details

I. General information

NPI: 1619715141
Provider Name (Legal Business Name): ERIK DOERR LAC, NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 TILTON RD
NORTHFIELD NJ
08225-1219
US

IV. Provider business mailing address

3315 OCEAN AVE
BRIGANTINE NJ
08203-1615
US

V. Phone/Fax

Practice location:
  • Phone: 609-667-7810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00799900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: