Healthcare Provider Details

I. General information

NPI: 1629786413
Provider Name (Legal Business Name): ERICA KIMMICK LPCC, CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29055 CLEMENS RD STE A
WESTLAKE OH
44145-1135
US

IV. Provider business mailing address

PO BOX 844020
DALLAS TX
75284-4020
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax: 888-494-1608
Mailing address:
  • Phone: 216-450-1613
  • Fax: 888-494-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606309
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.174116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: