Healthcare Provider Details

I. General information

NPI: 1730412511
Provider Name (Legal Business Name): CHIARA EBERHARDT LCSW, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 COLLEYVILLE BLVD STE 206
COLLEYVILLE TX
76034-5866
US

IV. Provider business mailing address

1614 AVENUE K
LUBBOCK TX
79401-5042
US

V. Phone/Fax

Practice location:
  • Phone: 214-533-7203
  • Fax: 972-220-0377
Mailing address:
  • Phone: 806-766-3763
  • Fax: 806-765-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number58858
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: