Healthcare Provider Details

I. General information

NPI: 1558255992
Provider Name (Legal Business Name): THE ERIC GROUP BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 COFFEEN AVE STE 1200
SHERIDAN WY
82801-5777
US

IV. Provider business mailing address

5802 ANNAPOLIS RD APT 1003
BLADENSBURG MD
20710-2077
US

V. Phone/Fax

Practice location:
  • Phone: 202-750-1535
  • Fax:
Mailing address:
  • Phone: 202-750-1535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARLAN HARRELL
Title or Position: CEO
Credential: EDD
Phone: 202-750-1535