Provider Demographics
NPI:1902692023
Name:VICI, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:VICI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21884 SW 88TH LANE RD
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-5604
Mailing Address - Country:US
Mailing Address - Phone:321-591-1688
Mailing Address - Fax:
Practice Address - Street 1:723 EMORY VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7017
Practice Address - Country:US
Practice Address - Phone:865-483-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst