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General NPI Number Information
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NPI Number | 1184251555
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Entity Type | Individual
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Provider Name | YASMEEN PATRICIA EICHELBERGER LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 510 GEORGE ST STE 201
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City | JACKSON
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State | MS
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Zip | 39202-3027
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Country | US
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Telephone | 601-248-7561
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Fax | 855-387-8203
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Provider Business Mailing Address
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Address Line | 4226 SUMMERTON DR
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City | BYRAM
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State | MS
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Zip | 39272-8738
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Country | US
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Telephone | 601-248-7561
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Fax | 855-387-8203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C5009
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License Number State | MS
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