Provider Demographics
NPI:1790434694
Name:EMMIC LLC
Entity Type:Organization
Organization Name:EMMIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC AND EDD
Authorized Official - Phone:305-766-1788
Mailing Address - Street 1:2157 HARWICK CIR SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-7859
Mailing Address - Country:US
Mailing Address - Phone:305-766-1788
Mailing Address - Fax:305-397-1010
Practice Address - Street 1:7900 OAK LN STE 400
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-6001
Practice Address - Country:US
Practice Address - Phone:305-766-1788
Practice Address - Fax:305-397-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty