Healthcare Provider Details

I. General information

NPI: 1730628231
Provider Name (Legal Business Name): SHIRLENE EADDY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 FOLSOM RD
RICHMOND VA
23234-2330
US

IV. Provider business mailing address

4206 FOLSOM RD
RICHMOND VA
23234-2330
US

V. Phone/Fax

Practice location:
  • Phone: 804-651-3290
  • Fax:
Mailing address:
  • Phone: 804-651-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006995
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: