Provider Demographics
NPI:1922315340
Name:ERMC
Entity Type:Organization
Organization Name:ERMC
Other - Org Name:ERMC COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:850-462-1611
Mailing Address - Street 1:3451 RIVERINA DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8158
Mailing Address - Country:US
Mailing Address - Phone:617-594-0325
Mailing Address - Fax:850-463-1612
Practice Address - Street 1:9910 GUIDY LN
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1670
Practice Address - Country:US
Practice Address - Phone:850-462-1611
Practice Address - Fax:850-462-1612
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-07
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6917101YM0800X
FLMH 12182101YM0800X
FLSW 122101041C0700X
FLSW 72941041C0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010365700Medicaid
FL004395700Medicaid
FL015031400Medicaid
FL015031400Medicaid
IG194ZMedicare PIN