Provider Demographics
NPI:1558658088
Name:YOUNG, ERIK (MED, LPC, LMHC)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MED, LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SAINT GEORGES RD APT 201A
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1127
Mailing Address - Country:US
Mailing Address - Phone:484-693-0582
Mailing Address - Fax:484-631-0502
Practice Address - Street 1:10000 SAINT GEORGES RD APT 201A
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1127
Practice Address - Country:US
Practice Address - Phone:484-693-0582
Practice Address - Fax:484-631-0502
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18719101YM0800X
PAPC005853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110212300Medicaid
PAPC005853OtherLICENSED PROFESSIONAL COUNSELOR
FLMH18719OtherLICENSED MENTAL HEALTH COUNSELOR