Provider Demographics
NPI:1578705356
Name:EAVES, DENISE R (LCSW, CEAP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:R
Last Name:EAVES
Suffix:
Gender:F
Credentials:LCSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34159 N. HAINESVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-9790
Mailing Address - Country:US
Mailing Address - Phone:847-543-7778
Mailing Address - Fax:
Practice Address - Street 1:135 N GREENLEAF ST
Practice Address - Street 2:200
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3393
Practice Address - Country:US
Practice Address - Phone:847-637-5239
Practice Address - Fax:847-637-5239
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490016911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical