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General NPI Number Information
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NPI Number | 1720195464
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Entity Type | Individual
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Provider Name | VICI LYNN ECKHART MSW LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 PETROL POINTE SUITE B 3
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1553
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Country | US
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Telephone | 770-841-8318
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Fax | 770-719-7846
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Provider Business Mailing Address
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Address Line | PO BOX 1432
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City | FAYETTSVILLE
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State | GA
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Zip | 30214-6432
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Country | US
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Telephone | 770-841-8318
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Fax | 770-719-7846
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LCSW CSW002904
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LSCSW1186
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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