Provider Demographics
NPI:1184029845
Name:GINA V EATON, LCSW, PA
Entity Type:Organization
Organization Name:GINA V EATON, LCSW, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-862-1736
Mailing Address - Street 1:12555 ORANGE DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4304
Mailing Address - Country:US
Mailing Address - Phone:954-862-1736
Mailing Address - Fax:954-862-1738
Practice Address - Street 1:12555 ORANGE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4304
Practice Address - Country:US
Practice Address - Phone:954-862-1736
Practice Address - Fax:954-862-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 3884261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)