Doctor Name: | MRS. LISA ANNE EIDELKIND |
NPI Number: | 1962803809 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | 0904003786 |
Business Practice Address: | 9127 Wood Pointe Way Fairfax Station, VA - 220393069 |
Business Phone Number: | 7038677221 |
Business Fax Number: | |
Mailing Address: | 9127 Wood Pointe Way, FAIRFAX STATION |
State: | VA |
Postal Code: | 220393069 |
Phone Number: | 7038677221 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2014 |
NPI Last Update Date: | 09/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 0904003786 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |