Provider Demographics
NPI:1225218084
Name:ATHEARN, ERIC M (LMHC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:ATHEARN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:ERIC
Other - Middle Name:M
Other - Last Name:ATHEARN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC
Mailing Address - Street 1:9951 ATLANTIC BLVD STE 100B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6558
Mailing Address - Country:US
Mailing Address - Phone:904-727-7778
Mailing Address - Fax:
Practice Address - Street 1:9951 ATLANTIC BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-6558
Practice Address - Country:US
Practice Address - Phone:904-727-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9292101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health