Healthcare Provider Details

I. General information

NPI: 1124490180
Provider Name (Legal Business Name): DAWN ROCHELLE EADEN M.ED., LPC, LCDCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 S LOOP W SUITE 200
HOUSTON TX
77054-2664
US

IV. Provider business mailing address

7337 HOWTON ST
HOUSTON TX
77028-4307
US

V. Phone/Fax

Practice location:
  • Phone: 832-945-1392
  • Fax:
Mailing address:
  • Phone: 713-562-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number74523
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC007519
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: