Provider Demographics
NPI:1417276353
Name:CRIDER, WARREN GLENN (LPC)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:GLENN
Last Name:CRIDER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W STATE ROAD 434 STE 1000
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4323
Mailing Address - Country:US
Mailing Address - Phone:386-346-5325
Mailing Address - Fax:
Practice Address - Street 1:400 W STATE ROAD 434 STE 1000
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4323
Practice Address - Country:US
Practice Address - Phone:386-346-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMHC1971101YM0800X
GALPC005947101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional