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General NPI Number Information
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NPI Number | 1104325315
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Entity Type | Organization
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Legal Business Name | ERIC SCHADE, LCSW, LLC
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Dates
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Enumeration Date | 02/03/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 1010 N 12TH AVE UNIT 327
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City | PENSACOLA
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State | FL
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Zip | 32501-3370
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Country | US
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Telephone | 850-361-8179
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Fax |
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Provider Business Mailing Address
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Address Line | 8531 SALT GRASS DR W
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City | PENSACOLA
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State | FL
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Zip | 32526-3260
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Country | US
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Telephone | 850-361-8179
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ERIC SCHADE
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Credential | LCSW
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Telephone | 850-361-8179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW15011
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License Number State | FL
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