Provider Demographics
NPI:1366818874
Name:EBERHART, ISABELLE SHAW (CDP)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:SHAW
Last Name:EBERHART
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:ISABELLE
Other - Middle Name:MARIE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:5455 ALMIRA DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311
Mailing Address - Country:US
Mailing Address - Phone:360-415-6709
Mailing Address - Fax:360-415-5828
Practice Address - Street 1:5455 ALMIRA DR NE
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8330
Practice Address - Country:US
Practice Address - Phone:360-414-6709
Practice Address - Fax:360-415-5828
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60519010101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)