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General NPI Number Information
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NPI Number | 1184029845
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Entity Type | Organization
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Legal Business Name | GINA V EATON, LCSW, PA
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Dates
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Enumeration Date | 10/23/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 12555 ORANGE DR SUITE 215
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City | DAVIE
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State | FL
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Zip | 33330-4304
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Country | US
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Telephone | 954-862-1736
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Fax | 954-862-1738
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Provider Business Mailing Address
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Address Line | 12555 ORANGE DR SUITE 215
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City | DAVIE
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State | FL
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Zip | 33330-4304
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Country | US
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Telephone | 954-862-1736
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Fax | 954-862-1738
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | GINA V EATON
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Credential | LCSW
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Telephone | 954-862-1736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | SW 3884
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License Number State | FL
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