Provider Demographics
NPI:1669823753
Name:GRITZEN, ERICA ALEXANDRIA (BA, CACP)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ALEXANDRIA
Last Name:GRITZEN
Suffix:
Gender:F
Credentials:BA, CACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 SHALOM DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7174
Mailing Address - Country:US
Mailing Address - Phone:570-498-3862
Mailing Address - Fax:
Practice Address - Street 1:2404 WISE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5521
Practice Address - Country:US
Practice Address - Phone:843-488-1300
Practice Address - Fax:843-488-1330
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)