Provider Demographics
NPI:1093861734
Name:EAVES, JUDITH ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:EAVES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANN
Other - Last Name:DECKHUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:208 COVENTRY LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2768
Mailing Address - Country:US
Mailing Address - Phone:803-808-2741
Mailing Address - Fax:
Practice Address - Street 1:2015 MARION ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2113
Practice Address - Country:US
Practice Address - Phone:803-898-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health