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General NPI Number Information
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NPI Number | 1982367942
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Entity Type | Organization
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Legal Business Name | SUSAN EICK PSYD INC
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 137 LAXTON RD STE 200
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City | LYNCHBURG
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State | VA
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Zip | 24502-5294
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Country | US
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Telephone | 434-993-8124
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Fax |
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Provider Business Mailing Address
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Address Line | 3043 SMOKY HOLLOW RD
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City | LYNCHBURG
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State | VA
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Zip | 24504-4347
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Country | US
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Telephone | 434-993-8124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN EICK
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Credential | PSYD
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Telephone | 434-933-8124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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