Provider Demographics
NPI:1568732543
Name:EDDY, DEANNA BISHOP (MS)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:BISHOP
Last Name:EDDY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PARTIN DR N
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2055
Mailing Address - Country:US
Mailing Address - Phone:850-960-8440
Mailing Address - Fax:850-810-0601
Practice Address - Street 1:117 PARTIN DR N
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2055
Practice Address - Country:US
Practice Address - Phone:850-960-8440
Practice Address - Fax:850-810-0601
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12700101YM0800X
FLIMH 9543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health