Provider Demographics
NPI:1578629713
Name:EAGLIN, ADRIENNE LACHELLE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:LACHELLE
Last Name:EAGLIN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:ADRIENNE
Other - Middle Name:LACHELLE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:44 WELLINGTON DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7331
Mailing Address - Country:US
Mailing Address - Phone:636-240-6506
Mailing Address - Fax:636-294-4132
Practice Address - Street 1:9167 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-1420
Practice Address - Country:US
Practice Address - Phone:314-521-7900
Practice Address - Fax:314-521-2786
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020273241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO183974OtherBLUE CROSS BLUE SHIELD