Provider Demographics
NPI:1518060805
Name:EDDINGTON, MICHAEL VERNON (MSW,LICSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VERNON
Last Name:EDDINGTON
Suffix:
Gender:M
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20520 NE 221ST CIR
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4922
Mailing Address - Country:US
Mailing Address - Phone:360-666-5545
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER(V3CNH)
Practice Address - Street 2:SAM JACKSON BLVD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000051251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical