Provider Demographics
NPI:1356003446
Name:DUPRISTLE, ERIN MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MICHELLE
Last Name:DUPRISTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:DUPREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1752 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-2368
Mailing Address - Country:US
Mailing Address - Phone:904-200-9760
Mailing Address - Fax:
Practice Address - Street 1:406 MCINTOSH AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4834
Practice Address - Country:US
Practice Address - Phone:904-375-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW174241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical