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General NPI Number Information
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NPI Number | 1629067004
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Entity Type | Individual
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Provider Name | SUSANE ERICKSON LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 3910 LEWIS SPEEDWAY STE 1103
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-8649
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Country | US
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Telephone | 904-829-2273
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Fax | 904-824-0724
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Provider Business Mailing Address
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Address Line | 3910 LEWIS SPEEDWAY STE 1103
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-8649
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Country | US
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Telephone | 904-829-2273
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Fax | 904-824-0724
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH7654
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7654
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2000
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License Number State | WV
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