Provider Demographics
NPI:1629786413
Name:KIMMICK, ERICA (LPC, CDCA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:KIMMICK
Suffix:
Gender:F
Credentials:LPC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 BROWNFIELD DR APT SUITE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4209
Mailing Address - Country:US
Mailing Address - Phone:440-381-6948
Mailing Address - Fax:
Practice Address - Street 1:11565 PEARL RD STE 200
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3356
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174116101YA0400X
OHC.2002622101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)