Provider Demographics
NPI:1326418534
Name:EICKHOLT-MARCH, JANICE ADRIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ADRIA
Last Name:EICKHOLT-MARCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:ADRIA
Other - Last Name:EICKHOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW, CADC
Mailing Address - Street 1:19507 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:NEW LOTHROP
Mailing Address - State:MI
Mailing Address - Zip Code:48460-9630
Mailing Address - Country:US
Mailing Address - Phone:810-818-7584
Mailing Address - Fax:810-228-7586
Practice Address - Street 1:19507 BISHOP RD
Practice Address - Street 2:
Practice Address - City:NEW LOTHROP
Practice Address - State:MI
Practice Address - Zip Code:48460-9630
Practice Address - Country:US
Practice Address - Phone:989-818-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01369101YA0400X
MI68011040341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2-01369OtherCERTIFIED DRUG AND ALCOHOL COUNSELOR