Provider Demographics
NPI:1376955450
Name:SHEPHERD, EIYAH ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:EIYAH
Middle Name:ELIZABETH
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E LA RUA ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-4108
Mailing Address - Country:US
Mailing Address - Phone:850-483-0334
Mailing Address - Fax:
Practice Address - Street 1:1000 E LA RUA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-4108
Practice Address - Country:US
Practice Address - Phone:850-483-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW118771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical