Provider Demographics
NPI:1043656028
Name:EDDY, VIRGINIA
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 CLYDESDALES CT
Mailing Address - Street 2:APT 201
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5516
Mailing Address - Country:US
Mailing Address - Phone:704-249-0142
Mailing Address - Fax:
Practice Address - Street 1:1758 CLYDESDALES CT
Practice Address - Street 2:APT 201
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-5516
Practice Address - Country:US
Practice Address - Phone:704-249-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional