Healthcare Provider Details

I. General information

NPI: 1265609887
Provider Name (Legal Business Name): BETTY EASTMAN LCSW AND ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CITY HALL AVE SUITE E
POQUOSON VA
23662-1985
US

IV. Provider business mailing address

200 CITY HALL AVE SUITE E
POQUOSON VA
23662-1985
US

V. Phone/Fax

Practice location:
  • Phone: 757-868-0072
  • Fax:
Mailing address:
  • Phone: 757-868-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004680
License Number StateVA

VIII. Authorized Official

Name: BETTY EASTMAN
Title or Position: PRESIDENT
Credential: LCSW
Phone: 757-868-0072