Provider Demographics
NPI:1093015794
Name:EILENBERG, LAURIE BARBRA (LPCC)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:BARBRA
Last Name:EILENBERG
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MONMOUTH ST
Mailing Address - Street 2:AWARENESS & DISCOVERY-MODLIN GROUP
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-7605
Mailing Address - Country:US
Mailing Address - Phone:859-431-7747
Mailing Address - Fax:859-431-3616
Practice Address - Street 1:225 E 3RD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1707
Practice Address - Country:US
Practice Address - Phone:859-291-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12257374OtherCAQH