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General NPI Number Information
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NPI Number | 1972629681
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Entity Type | Individual
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Provider Name | ELENA MARIE EAGAN C.R.C.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1420 WILLOW PASS RD SUITE 140
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City | CONCORD
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State | CA
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Zip | 94520-5223
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Country | US
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Telephone | 925-646-5775
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Fax | 925-646-5680
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Provider Business Mailing Address
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Address Line | 725 PARKWAY DR
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City | MARTINEZ
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State | CA
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Zip | 94553-3472
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Country | US
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Telephone | 925-228-0176
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Fax | 925-228-0989
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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 | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00052292
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License Number State | CA
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