Provider Demographics
NPI:1780148684
Name:YOUNG, ERIC COLE (CAC)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:COLE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 N WASHINGTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4256
Mailing Address - Country:US
Mailing Address - Phone:706-207-2714
Mailing Address - Fax:941-914-9333
Practice Address - Street 1:715 N WASHINGTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-4256
Practice Address - Country:US
Practice Address - Phone:706-207-2714
Practice Address - Fax:941-914-9333
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAC-100149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)