Healthcare Provider Details

I. General information

NPI: 1811609357
Provider Name (Legal Business Name): MARIEL FELICIA EAVES MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 LYCKAN PKWY STE 5007
DURHAM NC
27707-2539
US

IV. Provider business mailing address

711 AVON AVE
BURLINGTON NC
27215-6507
US

V. Phone/Fax

Practice location:
  • Phone: 919-748-3988
  • Fax:
Mailing address:
  • Phone: 919-617-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: