Provider Demographics
NPI:1326763632
Name:LIEUX, ERIK DAVIDSON
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DAVIDSON
Last Name:LIEUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 E COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-4555
Mailing Address - Country:US
Mailing Address - Phone:305-205-0476
Mailing Address - Fax:
Practice Address - Street 1:971 E COUNTRY CLUB CIR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-4555
Practice Address - Country:US
Practice Address - Phone:305-205-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19778101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health