Healthcare Provider Details

I. General information

NPI: 1205239738
Provider Name (Legal Business Name): EAP LIFESTYLE MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MAIN ST
DAPHNE AL
36526-4463
US

IV. Provider business mailing address

1605 MAIN ST
DAPHNE AL
36526-4463
US

V. Phone/Fax

Practice location:
  • Phone: 251-621-5360
  • Fax: 251-621-5361
Mailing address:
  • Phone: 251-621-5360
  • Fax: 251-621-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA A VANDERPOOL
Title or Position: PRESIDENT/OWNER
Credential: MS, LPC, CEAP
Phone: 251-621-5360