Provider Demographics
NPI:1689470361
Name:ERICA OTTO COUNSELING LLC
Entity type:Organization
Organization Name:ERICA OTTO COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:OTTO
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-770-7587
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 201A
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3119
Mailing Address - Country:US
Mailing Address - Phone:904-770-7587
Mailing Address - Fax:904-770-7817
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 201A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3119
Practice Address - Country:US
Practice Address - Phone:904-770-7587
Practice Address - Fax:904-770-7817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty