Basic Information
| Provider Information | |||||||||
| NPI: | 1194142943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUICK | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | KID | ||||||||
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| Credential: | LPC, LAC, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1497 FOREST HILL BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | LAKE CLARKE SHORES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334066052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614335687 | ||||||||
| FaxNumber: | 5614335705 | ||||||||
| Practice Location | |||||||||
| Address1: | 1497 FOREST HILL BLVD STE E | ||||||||
| Address2: | |||||||||
| City: | LAKE CLARKE SHORES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334066052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614335687 | ||||||||
| FaxNumber: | 5614335705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2014 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 175 | CO | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 6484 | CO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | MH14257 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.