Individual
SUSANE ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
3910 LEWIS SPEEDWAY STE 1103, SAINT AUGUSTINE, FL 32084-8649
(904) 829-2273
(904) 824-0724
Mailing address
3910 LEWIS SPEEDWAY STE 1103, SAINT AUGUSTINE, FL 32084-8649
(904) 829-2273
(904) 824-0724
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
7654
FL
101YM0800X
Mental Health Counselor
MH7654
FL
101YP2500X
Professional Counselor
Primary
2000
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
766307200
—
FL
01
—
Z086G
BCBS
FL
Enumeration date
10/18/2005
Last updated
04/09/2025
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